Attention deficit hyperactivity disorder or ADHD is a mental disorder of the neurodevelopmental type. It is characterized by problems paying attention, excessive activity, or difficulty controlling behavior which is not appropriate for a person’s age.The symptoms appear before a person is twelve years old, are present for more than six months, and cause problems in at least two settings (such as school, home, or recreational activities). In children, problems paying attention may result in poor school performance.Although it causes impairment, particularly in modern society, many children with ADHD have a good attention span for tasks they find interesting.
ADHD is not just a childhood disorder. Although the symptoms of ADHD begin in childhood, ADHD can continue into adolescence and adulthood. Even though hyperactivity tends to improve as a child becomes a teen, problems with inattention, disorganization, and poor impulse control often continue through the teen years and into adulthood.
Factors That Leads To ADHD
Researchers at the National Institute of Mental Health (NIMH), National Institutes of Health (NIH), and across the country are studying the causes of ADHD. Current research suggests ADHD may be caused by interactions between genes and environmental or non-genetic factors. Like many other illnesses, a number of factors may contribute to ADHD such as:
• Cigarette smoking, alcohol use, or drug use during pregnancy
• Exposure to environmental toxins, such as high levels of lead, at a young age
• Low birth weight
• Brain injuries
Is There Any Type Of ADHD?
• Primarily Inattentive type: People with inattentive Attention Deficit Hyperactivity Disorder make careless mistakes because they have difficulty sustaining attention, following detailed instructions, and organizing tasks and activities. They are forgetful, easily distracted by external stimuli, and often lose things. This is more common for adults and girls.
• Primarily Hyperactive-Impulsive type: People with hyperactive ADHD often fidget, squirm, and struggle to stay seated. They appear to act as if “driven by a motor” and often talk and/or run around excessively. They interrupt others, blurt out answers, and struggle with self-control. This is more common in children and men.
• Combined type: People with combined-type ADHD demonstrate six or more symptoms of inattention and six or more symptoms of hyperactivity and impulsivity.
How Do I Know I Have ADHD?
People with ADHD show an ongoing pattern of three different types of symptoms:
• Difficulty paying attention (inattention)
• Being overactive (hyperactivity)
• Acting without thinking (impulsivity)
These symptoms get in the way of functioning or development. People who have Attention Deficit Hyperactivity Disorder have combinations of these symptoms:
• Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities
• Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading
• Seem to not listen when spoken to directly
• Fail to not follow through on instructions, fail to finish schoolwork, chores, or duties in the workplace, or start tasks but quickly lose focus and get easily sidetracked
• Have problems organizing tasks and activities, such as doing tasks in sequence, keeping materials and belongings in order, keeping work organized, managing time, and meeting deadlines
• 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
• Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
• Become easily distracted by unrelated thoughts or stimuli
• Forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments
Signs of hyperactivity and impulsivity may include:
• Fidgeting and squirming while seated
• Getting up and moving around in situations when staying seated is expected, such as in the classroom or in the office
• Running or dashing around or climbing in situations where it is inappropriate, or, in teens and adults, often feeling restless
• Being unable to play or engage in hobbies quietly
• Being constantly in motion or “on the go,” or acting as if “driven by a motor”
• Talking nonstop
• Blurting out an answer before a question has been completed, finishing other people’s sentences, or speaking without waiting for a turn in conversation
• Having trouble waiting for his or her turn
• Interrupting or intruding on others, for example in conversations, games, or activities
Showing these signs and symptoms does not necessarily mean a person has ADHD. Many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms. If you are concerned about whether you or your child might have Attention Deficit Hyperactivity Disorder, the first step is to talk with a health care professional to find out if the symptoms fit the diagnosis.
Pathophysiology Of ADHD
Current models of ADHD suggest that it is associated with functional impairments in some of the brain’s neurotransmitter systems, particularly those involving dopamine and norepinephrine. The dopamine and norepinephrine pathways that originate in the ventral tegmental area and locus coeruleus project to diverse regions of the brain and govern a variety of cognitive processes. The dopamine pathways and norepinephrine pathways which project to the prefrontal cortex and striatum are directly responsible for modulating executive function (cognitive control of behavior), motivation, reward perception, and motor function these pathways are known to play a central role in the pathophysiology of ADHD. Larger models of Attention Deficit Hyperactivity Disorder with additional pathways have been proposed.
In children with ADHD, there is a general reduction of volume in certain brain structures, with a proportionally greater decrease in the volume in the left-sided prefrontal cortex.The posterior parietal cortex also shows thinning in ADHD individuals compared to controls. Other brain structures in the prefrontal-striatal-cerebellar and prefrontal-striatal-thalamic circuits have also been found to differ between people with and without ADHD.
Previously it was thought that the elevated number of dopamine transporters in people with Attention Deficit Hyperactivity Disorder was part of the pathophysiology but it appears that the elevated numbers are due to adaptation to exposure to stimulants.Current models involve the mesocorticolimbic dopamine pathway and the locus coeruleus-noradrenergic system. ADHD psychostimulants possess treatment efficacy because they increase neurotransmitter activity in these systems. There may additionally be abnormalities in serotoninergic, glutamatergic, or cholinergic pathways.
Executive function and motivation
The symptoms of ADHD arise from a deficiency in certain executive functions (e.g., attentional control, inhibitory control, and working memory). Executive functions are a set of cognitive processes that are required to successfully select and monitor behaviors that facilitate the attainment of one’s chosen goals.The executive function impairments that occur in ADHD individuals result in problems with staying organized, time keeping, excessive procrastination, maintaining concentration, paying attention, ignoring distractions, regulating emotions, and remembering details. People with ADHD appear to have unimpaired long-term memory, and deficits in long-term recall appear to be attributed to impairments in working memory. The criteria for an executive function deficit are met in 30–50% of children and adolescents with ADHD. One study found that 80% of individuals with Attention Deficit Hyperactivity Disorder were impaired in at least one executive function task, compared to 50% for individuals without Attention Deficit Hyperactivity Disorder . Due to the rates of brain maturation and the increasing demands for executive control as a person gets older, ADHD impairments may not fully manifest themselves until adolescence or even early adulthood.
ADHD has also been associated with motivational deficits in children. Children with ADHD find it difficult to focus on long-term over short-term rewards and exhibit impulsive behavior for short-term rewards.
How ADHD Is Diagnosed?
ADHD is diagnosed by an assessment of a person’s childhood behavioral and mental development, including ruling out the effects of drugs, medications and other medical or psychiatric problems as explanations for the symptoms. It often takes into account feedback from parents and teachers with most diagnoses begun after a teacher raises concerns. It may be viewed as the extreme end of one or more continuous human traits found in all people.Whether someone responds to medications does not confirm or rule out the diagnosis.
Diagnosis of ADHD using quantitative electroencephalography (QEEG) is an ongoing area of investigation, although the value of QEEG in ADHD is currently unclear. In the United States, the Food and Drug Administration has approved the use of QEEG to evaluate the morbidity of ADHD.
Self-rating scales, such as the ADHD rating scale and the Vanderbilt ADHD diagnostic rating scale are used in the screening and evaluation of ADHD.
How It Can Be Compared With Other Diseases?
Symptoms of ADHD such as low mood and poor self-image, mood swings, and irritability can be confused with dysthymia, cyclothymia or bipolar disorder as well as with borderline personality disorder. Some symptoms that are due to anxiety disorders, antisocial personality disorder, developmental disabilities or mental retardation or the effects of substance abuse such as intoxication and withdrawal can overlap with some Attention Deficit Hyperactivity Disorders. These disorders can also sometimes occur along with ADHD. Medical conditions which can cause Attention Deficit Hyperactivity Disorder type symptoms include hyperthyroidism, seizure disorder, lead toxicity, hearing deficits, hepatic disease, sleep apnea, drug interactions, untreated celiac disease, and head injury.
Primary sleep disorders may affect attention and behavior and the symptoms of ADHD may affect sleep. It is thus recommended that children with ADHD be regularly assessed for sleep problems.Sleepiness in children may result in symptoms ranging from the classic ones of yawning and rubbing the eyes, to hyperactivity and inattentiveness. Obstructive sleep apnea can also cause ADHD type symptoms.
Dietary Changes Can Help To Manage ADHD
Dietary modifications may be of benefit to a small proportion of children with ADHD. A 2013 meta-analysis found less than a third of children with Attention Deficit Hyperactivity Disorder see some improvement in symptoms with free fatty acid supplementation or decreased eating of artificial food coloring.These benefits may be limited to children with food sensitivities or those who are simultaneously being treated with ADHD medications. This review also found that evidence does not support removing other foods from the diet to treat ADHD.A 2014 review found that an elimination diet results in a small overall benefit. A 2016 review stated that the use of a gluten-free diet as standard Attention Deficit Hyperactivity Disorder treatment is discouraged. Iron, magnesium, and iodine may also have an effect on ADHD symptoms. There is a small amount of evidence that lower tissue zinc levels may be associated with Attention Deficit Hyperactivity Disorder. In the absence of a demonstrated zinc deficiency (which is rare outside of developing countries), zinc supplementation is not recommended as a treatment for ADHD. However, zinc supplementation may reduce the minimum effective dose of amphetamine when it is used with amphetamine for the treatment of ADHD.There is evidence of a modest benefit of omega 3 fatty acid supplementation, but it is not recommended in place of traditional medication.
Prognosis Of ADHD
An 8-year follow up of children diagnosed with ADHD (combined type) found that they often have difficulties in adolescence, regardless of treatment or lack thereof.In the USA, fewer than 5% of individuals with Attention Deficit Hyperactivity Disorder get a college degree, compared to 28% of the general population aged 25 years and older. The proportion of children meeting criteria for ADHD drops by about half in the three years following the diagnosis and this occurs regardless of treatments used. Attention Deficit Hyperactivity Disorder persists into adulthood in about 30–50% of cases.Those affected are likely to develop coping mechanisms as they mature, thus compensating to some extent for their previous symptoms.
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