Attention Deficit Hyperactivity Disorder (ADHD)

What is ADHD?

Tanya is a ten-year-old girl who is full of energy. Her teachers often complain that Tanya does not sit in one place without disturbing the other children, and that she doesn't pay attention in class. She is extremely active in games and outdoor activities, but does not know when to stop. Although Tanya's friends like to play with her, they get upset when she dominates over them and makes her own rules. At home, Tanya gets into trouble because of her uncontrolled behavior that irritates her siblings. She is not aware of the consequences of such unruly behavior but does her own thing.

This fictional narrative has been constructed to aid the understanding of this disorder by placing it in a real life situation.

You may have heard of or observed behavior like Tanya's in a child. This type of behavior indicates that the child may have a condition known as Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is a neurodevelopmental disorder that affects learning, concentration, and behavior. This condition causes persistent unrest, impulsive behavior, distraction, and over-activity. Children with ADHD may have difficulty in managing daily tasks at school and at home. ADHD is one of the most common disorders of childhood and may continue through adolescence and adulthood. 

What is not ADHD?

It is normal for children to be impulsive, highly energetic, talkative, aggressive with friends while playing, get easily distracted while learning, and so on. This behavior is normal as long as the child is able to manage daily tasks, and academics. This is not ADHD.

ADHD should not be confused with learning disability, another neurological condition that affects overall learning capabilities, that is, reading, writing, speaking, listening and math skills.

Types of ADHD

There are two main types of ADHD, and a third type is a combination of the two main types.

  • Hyperactive-impulsive type of ADHD: Children with this type of ADHD usually receive a diagnosis at a younger age than those with other types.

  • Inattentive type of ADHD: Children with this type of ADHD have trouble with concentration and staying focused on any activity. Parents may often ignore or not observe this condition which can exist at an early age. As children grow and their responsibilities increase, their difficulties in managing tasks and being organized becomes more apparent. 

Similarities and differences between learning disability and ADHD

ADHD is technically not a learning disability but it can interfere with learning. It is observed that ADHD and learning disability co-exist in around 15-20 percent of the children. Hence, parents need to understand the similarities and differences between both conditions. The mental health expert thoroughly assesses the symptoms, medical history, and conducts specific tests to rule out other co-morbid conditions.

ADHD

Learning Disability (LD)

Similarities

Neurological condition that affects how brain receives, processes and responds to information/stimuli

Neurological condition that affects how brain receives, processes and responds to information/stimuli.

Differences

A chronic behavioral disorder characterized by persistent hyperactivity, impulsiveness, and inattention.

A group of disorders that affect the way a person takes in, stores, and uses information, thereby impeding the learning capability.

Problems with basic functioning like organizing things, learning new skills, paying attention, focusing on details, following instructions or rules to complete a task, uncontrollable behavior.

Problems with listening, reading, writing, spelling, maths, which cause disorders known as dyslexia, dysgraphia, dyspraxia, dyscalculia.

Most often treated with medication and therapy. May include intervention program and remedial education.

Treated with behavioral therapy, alternate methods of learning like remedial education, individualized education plan (IEP), and intervention programs.

What causes ADHD?

Experts are not sure about the specific causes of ADHD but they observe that it may be due to low levels of neurotransmitters (dopamine and norepinephrine) that transmit messages. These neurotransmitters are associated with concentration, organization, and managing emotions.

Some of the factors that can cause ADHD include:

  • Genes: Several studies have inferred that about 80 percent of the times, ADHD is a genetic problem because neurotransmitters in the brain do not function properly.

  • Environmental factors: It is observed that if pregnant women smoke or consume alcohol, then the child is at a higher risk of being affected with ADHD. It is also observed that fetus or infants exposed to lead may have a higher risk of developing ADHD.

  • Psychosocial factors such as prolonged emotional neglect and problems in the family (marital discord, domestic violence) may cause ADHD in children.

  • Behavioral traits: In some cases, a child's difficult temperament can lead to ADHD. 

What are the signs of ADHD?

Parents and teachers are the first people to notice a change in the child's behavior and performance at school.

For a diagnosis of ADHD, the symptoms of ADHD must be present before age seven. More than seven symptoms must be clearly visible in different environments such as school, home and in social settings. Only when the symptoms cause significant difficulty in learning, behavior, and disrupt the child's normal functioning, can the condition be considered as ADHD.

Note: As these children move into adulthood, many of the symptoms may disappear. However, their impulsiveness and inattention could persist affecting their social and professional life.

It is important to know that although the child may have difficulties with academics, he or she may excel in another activity that he or she is interested in.  

Signs of inattention

Signs of hyperactivity/impulsiveness

Does not pay attention to teaching, struggles to follow instructions.

Restlessness, fidgeting with hands, feet; does not sit still for more than a few minutes.

Makes careless mistakes while reading, writing, or spelling.

Refuses to sit in the classroom, tries to distract everyone in the classroom by getting up and moving around or running.

Difficulty in organizing things and doing sequential activities (arranging books, doing homework).

Keeps running often instead of walking, climbs up and down, does not follow rules on the road, which makes parents anxious and worried with the fear of accident or injury.

Does not like routine tasks such as school work or homework. Gets bored easily with routine work.

Fights with friends, does not play fairly, refuses to share or accept his/her mistake.

Gets easily distracted by many external factors like noise, movement, and others.

Talks excessively, interrupts conversations, impatient and responds before the other person completes speaking.

Not able to take care of things (stationery, assignments, toys).

Shows emotion without hesitation, and is unable to control emotional outbursts.

Easily forgets instructions and other routine daily tasks (brushing teeth, wearing shoes, washing hands).

Acts impulsively without thinking about the consequence.

How is ADHD diagnosed?

There is no single medical, physical, or genetic test for ADHD.

As parents, you can consult the child's pediatrician or a mental health expert for diagnosis. Experts conduct various assessments like ADHD symptom checklists and standardized behavior rating scales. They also conduct medical tests to rule out the existence of other disorders or physical ailments (For example, high fever, learning disability, or problems at home) that could trigger any of the above symptoms.

Sometimes, other conditions like anxiety disorder, dyslexia, specific learning disability, or autism may co-exist with ADHD. Hence, a careful and comprehensive medical and educational assessment is essential to rule out the possibility of other conditions. If any other problem exists, then evaluation and treatment of these disorders is also necessary along with the treatment for ADHD.

Note: Children with hyperactivity as a predominant feature are more likely to be referred for treatment than children with primary symptoms of attention deficit.

Getting treatment for ADHD

Treatment may include a combination of therapy, counseling, behavioral and remedial education training. Treatment varies depending on the severity of symptoms, personality and health condition of the child. Most children learn to cope with the condition and go on to lead normal lives.

  • ADHD medication: Pharmaceutical medicines are used to control the symptoms of ADHD.

  • Psychotherapy: The therapist uses scientifically validated procedures to help children develop healthier and more effective habits. The therapist works with children to identify their negative behavioral patterns, and replaces them with positive reinforcing behaviors.

  • Cognitive Behavior Therapy (CBT): This type of therapy helps teachers and parents learn strategies to deal with a child's behavior. Rewarding the child for acceptable behavior, timing each activity, and scheduling routine or daily activities will help the child in coping with the condition to a great extent.

  • Family therapy or parental training: Parents, guardians, and siblings undergo a lot of stress and anxiety while taking care of a child with ADHD. Hence parental training is an important aspect of ADHD management. Parents and guardians are trained to learn and use alternative methods and strategies to help the child cope with the condition. Family therapy helps parents and siblings deal with the situation in a better way.

  •  Social skills training: Children are trained to learn appropriate social behaviors. Group therapy sessions in schools help in refining social skills and improving self esteem.

Note: It requires team effort (parents, teachers, mental health professionals, therapists) to help the child cope with ADHD.

Caring for a child with ADHD

In India, we all know that academic success is considered very important. Parents whose children have been diagnosed with ADHD are often worried that their child's academic or scholastic performance can be affected. However, when parents learn more about ADHD and how it affects their child, they also understand that the disorder is manageable.

The role of parents and teachers is very crucial in ADHD management.

Some of these guidelines can help:

  • Knowledge: Understanding ADHD helps you manage the situation.

  • Encouragement and support: Children with ADHD go through a lot of stress for not being able to cope with studies. As parents, your love and support will make the child feel secure. Be generous in praising the child when he/she completes an activity, or follows instructions. It is proven that even the best of treatments fail if the child is in an unsupportive home and school environment.

  • Activities: Some simple techniques of behavioral modification (reward, positive and negative reinforcement for increasing desirable behavior and reducing undesirable behavior), attention enhancing exercises (letter crossing, sorting pulses) helps in controlling the symptoms.

  • Schedule: Keep the same routine every day, from wake-up time to bedtime. Include time for homework, outdoor play, and indoor activities.

  • Organizing things: Have a place for everything, and keep everything in its place. This includes clothes, books, toys and other things that the child owns.

  • Homework and school work: Encourage your child to write assignments, make notes, keep a diary and record daily activities, etc.

  • Self-help: You can attend workshops on ADHD or join a support group where you can interact with parents who are addressing the same issue. Such activities will help you cope with the situation.

ADHD in adults

Experts observe that ADHD is a chronic condition and 2/3rd of the children who have had ADHD continue to have these symptoms in adulthood. This may cause many problems like being disorganized at work and home, inability to complete a tasks on time, impatience and restlessness while following instructions, boredom with routine and monotonous work, and trouble with relationships.

ADHD symptoms in adults is ignored because there is less evaluation of an adult's behavior and these symptoms are misunderstood as some other issue. It is not considered a major problem because other conditions like social anxiety, social phobia, mood problems, substance abuse, or other factors may overshadow the underlying problem. In such cases, adults continue to be affected with ADHD for a long time because it is not identified and treated.

Note: Stigma and lack of awareness in society can aggravate ADHD in adults.

ADHD symptoms in adults

Some of the ADHD symptoms in adults include:

  1. Disruptive attention span
  2. Mundane and routine tasks become boring
  3. Impulsive reaction to external factors, impulsive decision making
  4. Rash or distracted driving leading to injuries or accidents
  5. Inability to listen actively and interrupts conversations
  6. Inability to organize things or complete work on time
  7. Difficulty in keeping with work deadlines, which may cause anxiety and stress
  8. Low self confidence and self esteem if there is no support or understanding from family and friends

Diagnosis and treatment for adults with ADHD

The symptoms in adults are very subtle, which makes it difficult for the doctor to diagnose the condition as ADHD. Women may present the condition as anxiety or mood issues, and doctors may fail to recognize that the underlying problem is ADHD.

The mental health expert conducts a thorough assessment that includes recording the person's history right from childhood, previous medical history, and interviews with family and friends. Tests are conducted to check if there are any other physical or mental health issues that could overshadow ADHD.

For treatment, the expert examines the person's personality (strengths, skills and capabilities), behavior and then focuses on the positive aspects rather than the condition itself.

Note: It is very important to analyze the medical history before prescribing any treatment or medication for ADHD.

Coping with ADHD

People with ADHD have the ability to perform well but they need to put in extra energy and effort compared to other people, which can be frustrating. Understanding ADHD will help you deal with this difference and help you learn coping mechanisms to lead a normal life.

  • Learn about ADHD, reach out to an expert for better understanding.
  • Become an informed consumer and advocate for yourself.
  • Introspect your life, work and make changes that will suit your personality and lifestyle.
  • Keep yourself active with interesting and meaningful activities.

Many people who have been coping with ADHD since childhood say that it is a common condition and not a sign of weakness or low intellect. ADHD in fact enables the person to discover their strengths and talents. They can focus on these positive traits and achieve goals that are possible instead of thinking about the condition itself. As ADHD prevails through adulthood, it is best to get acquainted with it and deal with it, without losing hope.

Specialists for ADHD treatment

Children with ADHD may need to consult some of the following specialists depending on the severity of the condition.

  • Clinical psychologist: Assesses intellectual and emotional functioning, and conducts psychotherapy.

  • Educational psychologist: Assesses learning and behavior in children and evaluates their educational setting, cognitive, and intellectual functioning.

  • Speech and language pathologist: Assesses and diagnoses speech and language difficulties, which is a common problem in most learning disabilities.

  • Occupational therapist: Assesses the motor and visual-motor, cognitive-perceptual, sensory and daily functional skills of the child. These functions have a direct or indirect effect on the child's learning process.

  • Neurologist: Identifies if there is a possible damage to brain functions.

  • Psychiatrist: Diagnoses and treats severe behavioral and emotional problems and sometimes may prescribe medication.

  • Pediatrician: Provides medical services to infants, children, and adolescents.

  • Special educator: Children with special learning needs may often face difficulty in adapting to the mainstream education system,  as traditional educational programs may not be effective in teaching children with ADHD. Hence, to aid their learning and improve their cognitive abilities, special education focuses on using various alternate teaching resources (learning tools, instructional materials, audio-visual sources, technology).  Special educators are trained in this field and they facilitate such special education programs.


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