Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder
Overview

Attention Deficit Hyperactivity Disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

  • Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.
  • Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
  • Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.
Signs and Symptoms

Inattention and hyperactivity/impulsivity are the key behaviours of Attention Deficit Hyperactivity Disorder. Some people with ADHD only have problems with one of the behaviours, while others have both inattention and hyperactivity-impulsivity. Most children have the combined type of ADHD.
In preschool, the most common Attention Deficit Hyperactivity Disorder symptom is hyperactivity.
It is normal to have some inattention, unfocused motor activity and impulsivity, but for people with ADHD, these behaviours:

  • are more severe
  • occur more often
  • interfere with or reduce the quality of how they function socially, at school, or in a job
Inattention


People with symptoms of inattention may often:

  1. Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities
  2. Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading
  3. Not seem to listen when spoken to directly
  4. Not follow through on instructions and fail to finish schoolwork, chores, or duties in the workplace or start tasks but quickly lose focus and get easily side-tracked
  5. Have problems organizing tasks and activities, such as what to do in sequence, keeping materials and belongings in order, having messy work and poor time management, and failing to meet deadlines
  6. Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms or reviewing lengthy papers
  7. Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
  8. Be easily distracted by unrelated thoughts or stimuli
  9. Be forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments
Hyperactivity-Impulsivity


People with symptoms of hyperactivity-impulsivity may often:

  1. Fidget and squirm in their seats
  2. Leave their seats in situations when staying seated is expected, such as in the classroom or in the office
  3. Run or dash around or climb in situations where it is inappropriate or, in teens and adults, often feel restless
  4. Be unable to play or engage in hobbies quietly
  5. Be constantly in motion or “on the go,” or act as if “driven by a motor”
  6. Talk nonstop
  7. Blurt out an answer before a question has been completed, finish other people’s sentences, or speak without waiting for a turn in conversation
  8. Have trouble waiting his or her turn
  9. Interrupt or intrude on others, for example in conversations, games, or activities
Diagnosis of Attention Deficit Hyperactivity Disorder:

This requires a comprehensive evaluation by a licensed clinician, such as a psychiatrist, psychologist, or child psychiatrist with expertise in ADHD. For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind normal development for his or her age. The doctor will also ensure that any ADHD symptoms are not due to another medical or psychiatric condition. Most children with ADHD receive a diagnosis during the elementary school years. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present prior to age 12.

Difficulties:

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 mistaken for emotional or disciplinary problems or missed entirely in quiet, well-behaved children, leading to a delay in diagnosis. 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 the person ages. In young children with ADHD, hyperactivity impulsivity is the most predominant symptom. As a child reaches elementary school, the symptom of inattention may become more prominent and cause the child to struggle academically. In adolescence, hyperactivity seems to lessen and may show more often as feelings of restlessness or fidgeting, but inattention and impulsivity may remain. Many adolescents with ADHD also struggle with relationships and antisocial behaviours. Inattention, restlessness, and impulsivity tend to persist into adulthood.

Risk Factors

Scientists are not sure what causes Attention Deficit Hyperactivity Disorder. Like many other illnesses, a number of factors can contribute to ADHD, such as:

  • Genes
  • Cigarette smoking, alcohol use, or drug use during pregnancy
  • Exposure to environmental toxins during pregnancy
  • Exposure to environmental toxins, such as high levels of lead, at a young age
  • Low birth weight
  • Brain injuries

ADHD is more common in males than females, and females with ADHD are more likely to have problems primarily with inattention. Other conditions, such as learning disabilities, anxiety disorder, conduct disorder, depression, and substance abuse, are common in people with ADHD.

Treatment and Therapies

While there is no cure for ADHD, currently available treatments can help reduce symptoms and improve functioning. Treatments include medication, psychotherapy, education or training, or a combination of treatments.

Medication

For many people, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medication also may improve physical coordination. Sometimes several different medications or dosages must be tried before finding the right one that works for a particular person. Anyone taking medications must be monitored closely and carefully by their prescribing doctor.

Stimulants

The most common type of medication used for treating ADHD is called a “stimulant.” Although it may seem unusual to treat ADHD with a medication that is considered a stimulant, it works because it increases the brain chemicals dopamine and norepinephrine, which play essential roles in thinking and attention.

Under medical supervision, stimulant medications are considered safe. However, there are risks and side effects, especially when misused or taken in excess of the prescribed dose. For example, stimulants can raise blood pressure and heart rate and increase anxiety. Therefore, a person with other health problems, including high blood pressure, seizures, heart disease, glaucoma, liver or kidney disease, or an anxiety disorder should tell their doctor before taking a stimulant.

Talk with a doctor if you see any of these side effects while taking stimulants:decreased appetitesleep problemstics (sudden, repetitive movements or sounds);personality changesincreased anxiety and irritabilitystomach-achesheadaches

Non-stimulants.

A few other ADHD medications are non-stimulants. These medications take longer to start working than stimulants, but can also improve focus, attention, and impulsivity in a person with ADHD.
Doctors may prescribe a non-stimulant:

  • when a person has bothersome side effects from stimulants;
  • when a stimulant was not effective;
  • or in combination with a stimulant to increase effectiveness.
  • Although not approved specifically for the treatment of ADHD, some antidepressants are sometimes used alone or in combination with a stimulant to treat ADHD.
  • Antidepressants may help all of the symptoms of ADHD and can be prescribed if a patient has bothersome side effects from stimulants.
  • Antidepressants can be helpful in combination with stimulants if a patient also has another condition, such as an anxiety disorder, depression, or another mood disorder.


Doctors and patients can work together to find the best medication, dose, or medication combination

Psychotherapy

Adding psychotherapy to treat ADHD can help patients and their families to better cope with everyday problems.

Behavioural therapy is a type of psychotherapy that aims to help a person change his or her behaviour. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events.

Behavioural therapy also teaches a person how to monitor his or her own behaviour give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting

Parents, teachers, and family members also can give positive or negative feedback for certain behaviours and help establish clear rules, chore lists, and other structured routines to help a person control his or her behaviour.

Therapists may also teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training.

Cognitive behavioural therapy can also teach a person mindfulness technique, or meditation. So, a person learns how to be aware and accepting of one’s own thoughts and feelings to improve focus and concentration. The therapist also encourages 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.

Family and marital therapy can help family members and spouses find better ways to handle disruptive behaviours, to encourage behaviour changes, and improve interactions with the patient.

Education and Training

Firstly, children and adults with ADHD need guidance and understanding from their parents, families, and teachers to reach their full potential and to succeed. So, for school-age children, frustration, blame, and anger may have built up within a family before a child is diagnosed. However, parents and children may need special help to overcome negative feelings. Thus, mental health professionals can educate parents about ADHD and how it affects a family. In addition, they also will help the child and his or her parents develop new skills, attitudes, and ways of relating to each other.

Secondly, parenting skills training (behavioural parent management training) teaches parents the skills they need to encourage and reward positive behaviours in their children. Thus, it helps parents learn how to use a system of rewards and consequences to change a child’s behaviour. So, parents are taught to give immediate and positive feedback for behaviours they want to encourage, and ignore or redirect behaviours that they want to discourage. Finally, they may also learn to structure situations in ways that support desired behaviour.

In addition, stress management techniques can benefit parents of children with ADHD by increasing their ability to deal with frustration so that they can respond calmly to their child’s behaviour.

Support groups can help parents and families connect with others who have similar problems and concerns.Groups often meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.

Tips to Help Kids and Adults with ADHD Stay Organized

For Kids:

Parents and teachers can help kids with ADHD stay organized and follow directions with tools such as:

  1. Firstly, keeping a routine and a schedule. Keep the same routine every day, from wake-up time to bedtime.
  2. In addition, include times for homework, outdoor play, and indoor activities. Also, keep the schedule on the refrigerator or on a bulletin board in the kitchen.
  3. Then, write changes on the schedule as far in advance as possible.
  4. Organizing everyday items. As such, have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys.
  5. Accordingly, using homework and notebook organizers. Therefore, use organizers for school material and supplies. So, emphasize to your child the importance of writing down assignments and bringing home the necessary books.
  6. Being clear and consistent. Children with ADHD need consistent rules they can understand and follow.
  7. In addition, giving praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behaviour, and praise it.
For Adults:

Indeed, a professional counsellor or therapist can help an adult with Attention Deficit Hyperactivity Disorder learn how to organize his or her life withtools such as:

  • Keeping routines
  • Making lists for different tasks and activities
  • Using a calendar for scheduling events
  • Using reminder notes
  • Assigning a special place for keys, bills, and paperwork
  • Breaking down large tasks into more manageable, smaller steps so that completing each part of the task provides a sense of accomplishment.

In either case it is best to consult your psychiatrist.

By Dr SUSHIL KUMAR VASANTHKUMAR SOMPUR

Dr Sushil Kumar Sompur is a psychiatrist with over 20 years of clinical experience. He pursued his MB BS in 2004 from the very prestigious Rajiv Gandhi University of Health Sciences, Bangalore graduating from Mysore Medical College in 2004. He has an MD with 3 years of Successful completion of Residency in General Adult Psychiatry in 2010 from University of North Dakota, Fargo, USA. After that he has also earned his MBA (Healthcare Administration) in December, 2010 from the well reputed College of Health Sciences, Walden University, Minneapolis, USA. Dr. Sompur mainly focuses on Adult psychiatry, Geriatric psychiatry, Sleep and Sexual Disorders, De-Addiction, Adolescent and child psychiatry. Works as a Consultant Neuropsychiatrist at Antahkarana Clinic.

Apart from this he was also worked as a Resident Fellow, with full unrestricted Licensure, in Child Psychiatry at University of Utah, Salt Lake City, USA. He is a professional member of Indian Medical Association (IMA) and is also an active profile of Indian Psychiatric Society (IPS) of which he is a Life Fellow.

Dr. Sushil Kumar Sompur is currently practicing at Mindss Neurolinks - An antahkarana clinic pvt. ltd. venture in MCC B Block, Davanagere. You can avail a whole lot of services at his clinics that includes and is not limited to - Abnormal Behavior Treatment, Treatments for Depression Anxiety and other Neuroses, Bipolar disorder and Psychoses, Anger Management Therapy, Behavior and Thought Problems Counselling, Obsessive Compulsive Disorder Treatment, Treatment of Learning Disorders and Cognitive Behavioral Therapy among other types of counseling. He has also been successful with the use of hypnotherapy with Treatment Resistant Depression as well as Treatment of seizures or fits, Unusual pain problems and Medically Un-diagnosed Symptoms.

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