The term attention deficit hyperactivity disorder (ADHD) defines a chronic condition represented by a neurodevelopmental disorder, one of the most frequent conditions of this type, most often diagnosed around the age of 7.
What ADHD is
Hyperkinetic disorder with attention deficit is a condition that causes a lack of the ability to concentrate, impulsivity and hyperactivity.
The manifestations specific to this neurological disorder generally appear between the ages of 3 and 6, but the diagnosis generally comes after the age of 7, when the child starts school and the characteristics of ADHD become obvious.
Although attention deficit hyperactivity disorder does not affect cognitive abilities, it has a major impact on life and social integration, both for children (school difficulties, challenges in relating to classmates, etc.) and for adults (difficulties on a personal and professional level).
Types of ADHD
There are 3 different ways in which the hyperkinetic disorder manifests itself, depending on the symptoms that predominate in each individual:
- The predominantly inattentive type
The defining characteristic of this type of ADHD is the inability to concentrate and to carry tasks through to the end. People with this type of ADHD often face challenges in following directions, difficulties in organising their activity and often make mistakes caused by inattention.
Another characteristic frequently found in these individuals is the ease with which their attention can be distracted.
As a rule, this form of ADHD is more frequent among girls and can often remain undiagnosed because it does not interfere directly with other people's activity, as happens when hyperactivity predominates.
- The predominantly hyperactive-impulsive type
Most of the manifestations specific to this type of ADHD belong to the sphere of impulsivity and poor self-control. This category includes people who find it difficult to stay still for a long time (for example children during lessons, when their tendency is to get up often, which leads to disruption of the lesson).
Other characteristics frequently found in people with this type of ADHD are the presence of tics (e.g. moving the legs), a permanent state of agitation, a lack of patience (also expressed through frequently interrupting the person they are talking to), the need for instant gratification, etc.
- The combined type
This type of ADHD is the most frequently encountered and includes manifestations from both of the types described above: excess energy, a tendency towards impulsivity and difficulties with concentration. The specific symptoms and manifestations can vary over time and there may even be a transition towards a particular type of ADHD.
Causes and risk factors for ADHD
The causes underlying the manifestations characteristic of ADHD are complex and remain a concern for specialists in the field. Scientific research indicates that there is a multitude of factors that can influence the appearance of the manifestations specific to hyperkinetic disorder with attention deficit:
Genetic factors
In the past there was a belief that ADHD has a strong hereditary component. A series of scientific studies support the idea that more than half of the parents who experienced manifestations specific to ADHD during childhood will have a child who faces the same disorder. A possible explanation for this is the impact of genetic factors on the neurotransmitters in the brain (such as dopamine, serotonin, noradrenaline and epinephrine) involved in numerous cognitive functions.
Psychosocial factors
The difficulties experienced on a psychosocial level can also have a strong impact on the appearance of the manifestations specific to ADHD. In this category we include a disadvantaged social or family environment, which can manifest itself on several levels: a low standard of living, bullying, a low level of education, etc.
Environmental factors
The risk of ADHD can increase as a result of exposure to certain toxic substances, either during pregnancy or in early childhood. A common example in this direction is exposure to lead or pesticides. These can affect the brain on a neurological and cognitive level, aspects with a strong impact in ADHD.
Other risk factors worth mentioning here are smoking, alcohol consumption and anxiety or a high level of stress during pregnancy.
Complications at birth
Both premature birth and complications during birth (in particular those involving poor oxygenation of the baby's brain) can increase the risk of ADHD, by affecting the normal development of the brain. A low birth weight is also often associated with hyperkinetic disorder with attention deficit.
The symptoms of ADHD
The specific manifestations can be classified into two distinct categories of behavioural problems:
- Symptoms related to lack of attention
- Difficulties in following instructions or rules, both when it comes to school-type activities and when it comes to games
- The inability to pay attention to a particular activity (e.g. difficulties in finishing homework)
- Lack of attention when information is communicated verbally (they seem not to be listening when someone addresses them, even directly)
- Difficulties in organising and carrying through the tasks assigned to them or the ones they take on themselves
- Reduced memory capacity
- Easily distracted by external stimuli
- Frequently losing objects (e.g. toys, notebooks, pencils, etc.)
- Symptoms related to hyperactivity and verbal and motor impulsivity
- Logorrhoea (excessive talking)
- Excessive restlessness and the inability to keep a position on a chair, for example (clapping the hands or tapping the feet, fidgeting on the chair, etc.)
- Excessive running or climbing in the case of children
- They find it difficult to play quietly
- The need to be always on the move
- Difficulties in not interrupting conversations and in waiting their turn
- A reduced capacity to assess dangers
- Difficulties in controlling their impulses
These symptoms are most often recognised in children or adolescents.
In the case of adults, the diagnosis becomes more difficult because over time they have learned to cope with the symptoms by developing mechanisms for managing them. The manifestations of ADHD in adults include:
- Impulsivity
- Disorganisation and difficulties in prioritising tasks
- Poor time management skills
- Problems concentrating on a single task
- Problems with multitasking
- The need for excessive activity or restlessness
- Low tolerance of frustration
- Frequent mood swings
- Problems in following and completing tasks
- Difficulties in coping with stress
Diagnosing hyperkinetic disorder with attention deficit
Diagnosing ADHD is a challenge for mental health specialists, as there is a significant risk of incorrect diagnosis.
In the case of children and adolescents, hyperactivity and attention deficit do not automatically translate into a pathology; they can be normal characteristics related to personality, lifestyle, etc.
In the case of adults, being diagnosed with ADHD is an even greater challenge, all the more so as there is currently no standardised, universally accepted assessment for making the diagnosis. Another challenge of this diagnosis in adulthood is given by the need to research and build a clear picture of how the specific symptoms have evolved over a lifetime, as well as to analyse the way in which they are associated with other problems (for example anxiety, depression, addictions, etc.).
The diagnosis of ADHD is made by a specialist following a thorough case history. The specialist will carry out a clinical assessment of the patient and will analyse the presence and the intensity of the manifestations experienced by them (or by those around them, in the case of children), over a period of at least 6 months. For a diagnosis that is as accurate as possible, the doctor must take into account the environment in which the patient lives, the way in which the symptoms they have influence their social, personal or professional life, the relationships with family and close ones, results at school or at work, etc.
If you or your child present one or more of the manifestations specific to ADHD, we recommend a BrainMap investigation carried out by a specialist of the institute.
The treatment of ADHD
The aim of treatment in the case of attention deficit hyperactivity disorder is to improve the patient's quality of life, giving them the resources they need in order to control the symptoms of ADHD more easily. The direct consequence translates into an improvement in quality of life and self-esteem, and a positive impact in the academic or professional environment, in family life, etc.
In the case of ADHD, as in general with everything related to mental health, the best results require a holistic approach that may involve:
- Psychotherapy
The form of psychotherapy most frequently recommended in the case of ADHD is cognitive behavioural therapy. It will be carried out both in specially organised settings and within the family. The aim of cognitive behavioural therapy for patients with ADHD is to help them learn how to regulate their patterns of behaviour and how to manage more effectively the emotions they experience in everyday life.
One component of it involves carrying out activities that require closely following a set of clearly presented instructions (in an environment free of factors that can distract their attention), in stages, at the end of which there is a reward system for successfully meeting the requirements.
Most often, in the case of children, behavioural therapy involves an effort in terms of the involvement of teachers, parents and other family members.
- Neurofeedback
Neurofeedback therapy is a very gentle, painless form of therapy that is used successfully in treating the symptoms associated with ADHD. It is carried out by doctors, psychologists or psychotherapists and it not only fights the symptoms of this disorder, but also addresses its causes. Unlike conventional therapies, neurofeedback can be used from preschool children to adults.
- Drug therapy
At present there is no standardised drug treatment for ADHD. Stimulants are most often prescribed. They work by increasing the level of dopamine and norepinephrine in the brain, substances with a vital role both in general cognitive function and in motivation. Like any medicinal substance, these can be accompanied by side effects.
If stimulants are not a viable treatment option, there are also non-stimulant drug treatment options. Their effectiveness can be similar, but it will usually take longer before their effects can be observed.
- Lifestyle changes
There are a number of changes that can be implemented in order to minimise the symptoms specific to ADHD, including:
- Rigorous sleep hygiene and sufficient rest
- A balanced diet
- Regular physical activity and time spent outdoors, away from stimuli such as phones, TV, etc.
Complications associated with ADHD
The quality of life of a person with ADHD can drop drastically in the absence of a correct early diagnosis. Among the most frequent complications associated with this disorder we mention:
- Low self-esteem
- The coexistence of other disorders with a major impact on mental health (depression, anxiety, etc., which can increase the risk of suicide attempts)
- Eating disorders
- Reduced or even insufficient academic or professional performance, which can later translate into instability at work
- Sleep disturbances
- An increased risk of frequent accidents and injuries
- Excessive consumption of alcohol or illegal substances
- Instability in personal relationships
- Risky or impulsive behaviours, which can lead to financial difficulties or problems with the law
Preventing ADHD
Hyperkinetic disorder with attention deficit cannot be prevented, but there are a number of measures that can help to reduce the risk of the symptoms specific to ADHD appearing:
- Increased attention to lifestyle during pregnancy - smoking and the consumption of alcohol and drugs can strongly affect the development of the foetus.
- Avoiding exposure to pollutants and toxins, from cigarette smoke to lead or pesticides.
- Limiting screen exposure for children under the age of 5, in order to minimise the time spent in front of tablets, televisions, computers, video games, etc. and to reduce exposure to very strong stimuli.
Bibliography
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