Attention deficit hyperactivity disorder

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Introduction

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder whose onset is mostly between 3-6 years old. The chief distinctive symptoms are inattention, hyperactivity, and impulsivity. ADHD affects more than 51.1 million people globally. The disease is predominant in males than females, that is, it is three times more prevalent in men than females. The females are likely to be misdiagnosed since the disease presents with a different myriad of symptoms. 30-50% of the children proceed with the condition to adulthood. However, only about 2-5% of these adults manifest the disease (Visser et al., 2014). Most of the remaining adults acclimatize with the disease by developing coping skills, for example, most only present with inner restlessness instead of hyperactivity. The aim of this paper is to inform the patient about ADHD, causes, symptoms, and treatment. The paper will give insight into new information regarding ADHD.

Alexander Crichton observed the presence of hyperactivity in children in 1798. He described the condition with the symptoms of inattentiveness and fidgeting. However, George Still was the first person to fully describe the disease in 1902. Still gave a lecture to a conference of physicians in London. He further asked the physicians to start diagnosing the disease in children. In 1952, the term “minimal brain dysfunction” was coined. In 1968, following further studies, the researchers agreed to change the name to the hyperkinetic reaction of childhood. In 1980, the term was changed to attention deficit disorder (ADD). ADHD is the current term developed in 1994.

ADHD is divided into three types based on the most predominant symptom (Voort et al., 2014). First, inattentive presentation where an individual finds it challenging to complete a given task or even to follow a conversation or instructions. These persons tend to forget and are easily distracted from their duties. The second one presents as a predominantly hyperactive-impulsive disorder. The individual fidgets and is talkative. The person finds it challenging to sit patiently for extended periods. The person may interrupt people often. Hyperactive-impulsive people are more susceptible to accidents and other forms of injuries. The third type is a combination of the mentioned two types of ADHD.

Causes of ADHD

The chief causes of ADHD remain unknown and are still under research. However, some studies associate ADHD to genetic, environmental, and social factors. One of the studies indicates that children of parents with ADHD have a 75% chance of developing the condition. Brain scans and experiments reveal that dopaminergic transmission is relatively low in these children. Several genes are responsible namely, DAT, DRD4, DRD5, and COMT. For example, the latrophilin 3 gene is responsible for approximately 9% of the cases and that such patients are responsive to stimulants (Faraone & Larsson, 2019). Environmental factors play a significant role in ADHD. For example, alcohol intake during pregnancy causes fetal alcohol syndrome. Other causative agents include lead toxicity, organophosphate exposure, while nicotine smoking during pregnancy impairs brain development. The other risk elements include low birth weight and premature birth. Infections such as measles, rubella, and varicella-zoster lead to ADHD in susceptible patients. Watching too much TV, family dramas, or violence and also too much parenting exacerbate ADHD signs and symptoms.

Both dopamine and norepinephrine impairment lead to ADHD. The dopaminergic and norepinephrine signaling pathways modulate higher brain functions such as reward, motivation, behavior, and motor functions. Hence, their dysfunction has been proposed to cause symptoms of ADHD (Faraone & Larsson, 2019). Consequently, ADHD patients develop difficulties in keeping time, concentrating, commemorating tasks and details, staying attentive, and also modulating their emotions. Besides, the children find it hard to focus on performing long-term rewards as compared to short term duties. It is regular for normal individuals to lose attention, become impulsive, and also have irregular motor activity. However, for ADHD patients such symptoms tend to occur frequently and are more severe.

Diagnosis

The diagnosis of children with ADHD is a multiple-step process. The clinicians usually have to rule out other conditions with similar symptoms such as depression, anxiety, and learning complications. The HCPs check out each of the symptoms displayed against the guidelines. The standard norm is to rule out all the patients that manifest symptoms for less than six months and persons older than 12 years (Barkley, 2014). The DSM-5 is commonly used in America, while the ICD-10 has been adopted by the Europeans to diagnose ADHD. History taking process must indulge parents, teachers, and occasionally the child. Most of the time the parent or the teacher are the first notice that there is a problem. For example, the teacher may notice that the student is always fidgeting or unable to complete a given task. Academic performance is perhaps the most crucial manner through which the diagnosis is made as the teacher can compare the student’s character and performance with the rest of the students. ADHD occurs along with other conditions such as sleep disorders, epilepsy, substance abuse, anxiety disorders, and learning disabilities. Autism and sleep disorders are prevalent in ADHD children. Clinicians have to conduct a differential diagnosis to exclude the presence of comorbid conditions. It is crucial to note that some patients may manifest more than one condition, hence, proper diagnosis is necessary. Girls tend to manifest fewer symptoms of hyperactivity and impulsivity but display more symptoms of inattention, which explains the less prevalence in females. Symptoms of hyperactivity tend to diminish with age as the person adopts coping skills (Faraone & Larsson, 2019).

Individuals with ADHD have poor social skills hence are likely to have few friends. The situation is attributed to poor concentration and deficient social skills. The friends may find these characters annoying and therefore opt to reject them. The children thus find it difficult to form mature friendships and also other relationships. The patients tend to have emotional dysfunction. The children lag in speech and motor development. Studies show that ADHD children have low IQ scores. However, the results are not conclusive since they do not accommodate the low concentration levels in this population. The studies also exclude the presence of comorbid health conditions.

Treatment

There is no absolute cure for ADHD but the following therapies reduce symptoms and improve their functioning thus improving the child’s quality of life. The key techniques include medications such as stimulants and non-stimulants, psychotherapy, and behavioral therapy. The stimulants work by enhancing dopaminergic and norepinephrine signaling pathways involved in cognitive functions such as attention and thinking processes. Stimulants such as methylphenidate are the medications of choice and reduce short term symptoms in approximately 80% of the patients (Barkley, 2014). Non-stimulants such as atomoxetine, bupropion, and clonidine may be used either as adjuncts or as alternatives to stimulants. Non-stimulants have a slow onset of action. The use of medications is generally contraindicated in children below 5 years. Other therapies are preferred in such children. Stimulants have serious adverse effects such as tachycardia, hypertension, anorexia, mood changes, irritation, anxiety, headache, and insomnia. Doctors may sometimes prescribe antidepressants along with stimulants to manage symptoms of depression. The clinicians need to follow up on the patients and also conduct patient education. An overdose of stimulants may cause stimulant psychosis. Regular monitoring is necessary to assess the need for therapy and tolerance. Stimulant medications are prone to misuse and addiction hence, careful monitoring is essential.

For pre-school children and those with mild symptoms, behavioral therapies are recommended as the first-line treatment (Barkley, 2014). Behavioral therapy is a type of psychological therapy whose objective is to aid a person to change their character. The management process is more practical where the child is guided on how to undertake tasks and how to control their emotions. The child is taught how to check their behavior and ways of appraising themselves for behaving in a specific manner. Behavioral therapy works best when all the stakeholders are involved especially, the teachers and friends. In the end, the child learns social skills, language, and also how to read and interpret the facial expressions of other persons.

Cognitive behavioral therapy (CBT) teaches the child meditation techniques. Meditation improves the concentration span and focus by aiding the person to be conversant with their surroundings, thoughts, and feelings. Consequently, it improves thinking and attention. Family therapy is recommended to improve patient interaction. The parents need to be taught skills they can use to encourage positive behavior (Feldman & Reiff, 2014). For example, structural situations that promote desired behavior and at the same time discourage negative behavior. Most mechanisms teach parents the reward techniques which may intrigue a child with ADHD. Parents are also taught stress management techniques. Parents and guardians are encouraged to join support groups. Support groups provide forums where parents can meet to share their frustrations and successes. The parents may also learn new techniques on the recommended management methods. Teachers and learning institutions must also be streamlined to accommodate pupils with ADHD. Many schools in America offer special education for this population. The learning institutions have a special curriculum for ADHD students. The teachers are trained on how to handle students with low concentration spans. The services are free for children within the same locality as the school.

ADHD patients may also need to alter their lifestyles. Regular physical exercise particularly aerobics improves ADHD symptoms and may decrease inattention. The children need to be discouraged from watching too much television as it has been shown to exacerbate the symptoms. Adequate sleep may improve cognition and long-term memory. Healthy eating habits such as eating sufficient amounts of vegetables, fruits, and fiber may go a long way to improve the symptoms. Omega-3 supplements may improve the symptoms. Proper mineral intake of zinc and iron may diminish severe symptoms of ADHD. The goal of treatment is to improve the patient’s quality of life.

Conclusion

ADHD is a mental disorder that manifests early in development. The main causes remain unknown, however, clinicians, teachers, parents, and society need to come together to fight this condition. Public sensitization is essential to inform the community of how the disease manifests and also how to live with it. Sensitization is essential to avoid the stigmatization that comes along with the condition. Researchers should conduct more studies to determine the causes and also to establish evidence-based treatment guidelines. Consequently, more people should volunteer in the clinical trials to determine if a new treatment or test is safe and effective.

References

Barkley, R. A. (Ed.). (2014). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. Guilford Publications.

Faraone, S. V., & Larsson, H. (2019). Genetics of attention deficit hyperactivity disorder. Molecular psychiatry, 24(4), 562-575.

Feldman, H. M., & Reiff, M. I. (2014). Attention deficit–hyperactivity disorder in children and adolescents. New England Journal of Medicine, 370(9), 838-846.

Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., … & Blumberg, S. J. (2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. Journal of the American Academy of Child & Adolescent Psychiatry, 53(1), 34-46.

Voort, J. L. V., He, J. P., Jameson, N. D., & Merikangas, K. R. (2014). Impact of the DSM-5 attention-deficit/hyperactivity disorder age-of-onset criterion in the US adolescent population. Journal of the American Academy of Child & Adolescent Psychiatry, 53(7), 736-744.