What are the other Names for this Condition? (Also known as/Synonyms)

• ADHD (Attention Deficit Hyperactivity Disorder) 

What is Attention Deficit Hyperactivity Disorder? (Definition/Background Information)

• Attention Deficit Hyperactivity Disorder (ADHD) is termed as a neurodevelopmental disorder (brain and/or spinal cord impairment) which begins in childhood (typically, in children aged around 12 years)
• It is characterized by inattention (difficulty in staying attentive), hyperactivity (excessively active) and impulsivity (acting without thinking about the consequences)
• The cause of Attention Deficit Hyperactivity Disorder is currently unknown. Though some risk factors have been identified, they are not well linked to the disorder
• ADHD is an incurable disorder; however, it can be managed adequately with prompt diagnosis and treatment

Who gets Attention Deficit Hyperactivity Disorder? (Age and Sex Distribution)

• Attention Deficit Hyperactivity Disorder is most common in children. Once diagnosed in childhood, it is usually carried onto adulthood
• It has been estimated that around 11% of children and 3% of adults are affected by ADHD
• The condition is twice more common in boys (13%) than in girls (5%)
• It is seen worldwide and there is no geographical restriction. ADHD is observed in all ethnicities and races

What are the Risk Factors for Attention Deficit Hyperactivity Disorder? (Predisposing Factors)

Currently, there are no well-established risk factors for Attention Deficit Hyperactivity Disorder (ADHD). Of all the risk factors speculated, scientists believe that genetics (hereditary factors) may have a bigger role to play, at least in about 75% of the cases.

• Environmental factors, such as exposure to tobacco, may play a role
• Smoking or alcohol intake during pregnancy may place the developing fetus at an increased risk of ADHD. Smoking can cause hypoxia of the fetus in utero
• Low birth-weight and premature delivery of the child have been implicated
• Head injury (injury to the front part of the brain) may play a role
• Consumption of preserved food with sodium benzoate; the preservative may be linked to ADHD
• Social factors: According to the World Health Organization (WHO), family dysfunction and inadequacies in education are key factors for ADHD, rather than individual psychopathology
• Dopamine (a brain chemical) abnormality is also linked to ADHD
• Chlorpyrifos: An organophosphate insecticide used for growing fruits and vegetables can cause learning delays, reduced physical coordination, and behavioral problems in children
• Some factors that were believed to be linked to ADHD, such as watching television, excess sugar consumption, imbalance in family situation, poverty, poor parenting, etc., have been disproved in recent studies

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Attention Deficit Hyperactivity Disorder? (Etiology)

The mechanism and cause of Attention Deficit Hyperactivity Disorder is currently unknown.

• Scientists believe that genetic factors may play a big role among all the other known factors associated with the development of ADHD
• The following observations have been made in individuals with ADHD:
  • There is a reduction of brain volume
  • The derangement of function of various parts of the brain, such as the frontal lobe of brain, prefrontal cortex, and cerebellum, were observed
  • Reduced blood circulation and lower concentrations of dopamine have been implicated

What are the Signs and Symptoms of Attention Deficit Hyperactivity Disorder?

Individuals with Attention Deficit Hyperactivity Disorder (ADHD) are categorized into one of the 3 groups based on their predominant symptoms:

• Predominantly inattentive ADHD
• Predominantly hyperactive/impulsive ADHD
• Combined inattentive and hyperactive/impulsive ADHD

Problems predominantly associated with inattention are:

• Getting easily distracted, missing details, forgetting things, and frequent switching from one activity to another
• Inability to focus on one task for long periods, being bored after a few minutes, having difficulty focusing and organizing tasks, day-dreaming, moving slowly
• Not paying attention when one is spoken to
• Have difficulty processing and following orders (instructions), as quickly and accurately as compared to other individuals

Children with hyperactivity ADHD may have the following:

• Fidgeting and squirming if seated, talking non-stop (excessive), dashing around, touching and playing with any material in sight, having trouble sitting still during mealtime, being constantly in motion, always “on the go”
• Using inappropriate comments, being very impatient, having difficulty waiting for things (difficulty waiting for their turn)

In children with ADHD combined type, features of hyperactivity/impulsivity, as well as inattention, may be present.

• Up to 50% of ADHD affected individuals have associated conditions such as:
  • Oppositional defiant disorder: Negative defiant hostile behavior towards individuals in authority
  • Conduct disorder: Antisocial behavior such as stealing, fighting, destroying property, harming people or animals
  • Difficulty in maintaining or having friends (peer relationships)
  • Learning difficulties, such as reading, handwriting problems
  • Prone to injury in comparison to with other individuals

  • Depression and bipolar disorders (mania and depression alternately), Tourette syndrome (neurological disorder with compulsive muscle or vocal tics) can occur with ADHD

• About 80% of the children with ADHD may continue to have symptoms into their adulthood
• Adults with ADHD may have difficulty controlling anger, anxiety, depression, poor organization skills, employment issues, punctuality problems, low self-esteem, and may be impulsive and forgetful
• There is an association of bedwetting with Attention Deficit Hyperactivity Disorder

How is Attention Deficit Hyperactivity Disorder Diagnosed?

The following tools are used in the diagnosis of Attention Deficit Hyperactivity Disorder:

• A diagnosis may be formally made by a psychiatrist or primary care clinicians. They may also make a provisional diagnosis after examining the individual
• Thorough evaluation of the individual’s medical history, a thorough physical examination, laboratory blood tests, and imaging tests may be performed to rule out other associated medical illnesses
• There may be certain medical conditions that may mimic ADHD or cause ADHD-like symptoms. These conditions include:
  • Sudden changes that affect one’s life such as death of a family member/friend, separation, or moving to a different area
  • Undetected seizures, thyroid abnormalities, sleep-associated conditions, anxiety, depression, and even lead toxicity
• Attention Deficit Hyperactivity Disorder is diagnosed by psychiatric assessment, to rule out other illnesses that have similar symptoms
  • Sometimes, a diagnosis of ADHD in adults is missed
  • An adult must have childhood-onset and persistent current symptoms. A history of the adult’s behavior as a child is obtained from the parents, close friends, or teachers and correlated before making a diagnosis of ADHD

ADHD is diagnosed based on DSM-5 criteria (2013, of the American Psychological Association):

• The criteria is based on noticing (observation) inattention, hyperactivity, and impulsivity in the individual
• The symptoms should occur in more than two settings, for example, at home, school, or public places
• The diagnosis of ADHD should be made before the age of 12 years
• The symptoms should show interference with the development of the individual or proper functioning of the individual
• Individuals should have 6 of the inattentive symptoms and/or 6 of the hyperactivity/impulsivity symptoms
• The symptoms should be present in the individual for a minimum period of 6 months
• The symptoms should not be accountable to other medical or mental illnesses, or medications or drugs
• The inattentive symptoms are:
  • Being careless
  • Not being able to pay attention
  • Not being able to follow instructions properly
  • Difficulty in organizing oneself
  • Avoiding certain tasks
  • Being forgetful
  • Getting easily distracted
• The hyperactive/impulsive symptoms are:
  • Getting easily distracted
  • Not being able to enjoy leisure activities
  • Talking excessively
  • Answering before a question is asked completely
  • Not waiting for their turn
  • Intrude other people’s conversation
  • Running or climbing, whenever there is a chance
  • Always being “on the go”
  • Being extremely fidgety
  • Having difficulty sitting in one place 

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Attention Deficit Hyperactivity Disorder?

The complications of Attention Deficit Activity Disorder (ADHD) may include:

• If ADHD is not promptly diagnosed at an early age and not treated appropriately, the child may have difficulties with proper functioning in day-to-day activities. They may not be able to properly integrate into the family, school, or society
• Associated illnesses, such as depression, oppositional defiant disorder, conduct disorder, difficult relationship with peers, anxiety, or frequent injury can further worsen ADHD

How is Attention Deficit Hyperactivity Disorder Treated?

Attention Deficit Hyperactivity Disorder (ADHD) is lifelong disorder. The treatment and monitoring of the condition is important throughout the lifetime of the individual.

• Involvement of parents, therapist, school teachers, counselors, and psychologists may be required. In older adults, occupational therapy may be beneficial
• Education of parents and the child about the diagnosis, expectations, and treatment
• For preschool children with ADHD, individual parent teaching sessions or group sessions are helpful
• For preschool children, behavioral therapy is started first and if required medications are suitably added
• For older children, adolescents, and adults, a combination of both medications and behavioral therapy is usually helpful
• Behavioral therapy involves both the parents and teachers in strategically dealing with difficult situations with respect to the affected child. These strategies may include having a token reward system, giving timeouts, etc.
• Behavioral therapy also includes:
  • Helping the individual follow a routine
  • Helping them to get organized
  • Removing distractions, as much as possible
  • Limiting their choices to 2, when they have to choose between different items/substances
  • Constantly reminding them about their responsibilities
  • Discovering hidden talents and being appreciative of efforts of the individual, which will improve self-esteem
• Psychotherapy and family therapy: This helps older children in talking about the issues that bother them, explore negative behavior patterns, and ways to deal with them
• The class of medications used to treat ADHD include stimulants and non-stimulants
  • The commonly used stimulants are methylphenidate, amphetamine, dextro-amphetamine, and meth-amphetamine
  • The non-stimulants used include atomoxetine, bupropion, clonidine, etc.
  • Antidepressants, anti-anxiety drugs, etc. that may be used for associated conditions
• Social skills training support groups and exercises have been of benefit in treating the disorder, especially in adolescents and adults 

How can Attention Deficit Hyperactivity Disorder be Prevented?

Currently, there are no preventive measures for Attention Deficit Hyperactivity Disorder. However, there are steps that can help in dealing with the condition. These include:

• Setting consistent time limits, reminding them about their responsibilities, setting a daily routine, working with caregivers and teachers to identify the problems early, etc.
• During pregnancy, the mother should avoid smoking, alcohol and drug abuse, and substances that may likely cause ADHD in the child

What is the Prognosis of Attention Deficit Hyperactivity Disorder? (Outcomes/Resolutions)

• Attention Deficit Hyperactivity Disorder is a disorder that cannot be cured. Nevertheless, it can be effectively treated using behavioral therapy and medications
• Around 80% of the children have this condition as adults. They can lead relatively normal lives with good support system, follow-ups, behavioral therapy, medications, and suitable occupational therapy
• Any parent who notices any developmental problem, such as learning difficulty, problems at school, etc., should seek the help of a healthcare provider at an early stage

Additional and Relevant Useful Information for Attention Deficit Hyperactivity Disorder:

Parents should not be worried about their child being labelled as ADHD-affected, because it is a disorder where the child needs help and support to lead a productive life, when they reach adulthood.