Attention Deficit Hyperactivity Disorder (ADHD) is a mental health disorder affecting children and adults. It is characterised by acts of impulsivity, hyperactivity, lack of focus and inattentiveness. Like most mental illnesses, ADHD too, is deeply misunderstood. There have been a lot of myths and misconceptions around the concept of ADHD, with many people believing ADHD is not a real mental illness.
It is pertinent that we understand ADHD with some clarity—inattention and hyperactivity/impulsivity are traits commonly observed in ADHD patients. These factors interfere in the development and functioning of an individual. Some people may have a problem with one of the behavioural patterns that is they are predominantly inattentive or predominantly impulsive-hyperactive. Most children/adults have the combined type of ADHD they are both inattentive and hyperactive-impulsive.
So, we spoke to Dr. Vinod Kumar, Head at MPower, The Centre Bengaluru, to understand ADHD in detail—the types, signs and symptoms, what causes it and how to manage it. Here’s what he had to say:
Signs & Symptoms Of Inattentive Type
- Difficulty in maintaining focus on one task.
- Mind seems to be wandering when spoken to.
- Overlook and miss important details.
- Make careless mistakes in work, schoolwork, homework etc.
- Easily distracted and forgetful of daily activities.
- Moves from one task to another due to boredom, (unless doing an enjoyable activity) often leaving them incomplete.
- Avoid or dislike activities that require mental effort like reading, playing chess etc.
- Struggle to follow instructions, difficulty in processing information.
- Lose essential items with relative ease.
- Struggle with organisational skills and time management.
Signs & Symptoms Of Hyperactivity-Impulsivity
- Inability to sit still while doing work, watching TV etc.
- Constantly on the move.
- Fidgeting and squirming are a regular activity.
- Being highly impatient, trouble waiting for their turn.
- Talk excessively, nonstop.
- Make inappropriate comments in serious situations.
- Act impulsively without thinking; that is without regard for the consequences for their actions.
- Often show their emotions openly, without restraint.
- Often interrupts or intrudes other people.
In general, common to both categories, people with ADHD may have difficulty in work/schoolwork, relationship problems and problems with social skills. In many cases, other problems such as depression, anxiety, epilepsy, autism spectrum disorder (ASD), learning disorders and dyslexia may coexist alongside or mimic ADHD.
How Common Is It?
The prevalence of ADHD varies across the globe. It is estimated to affect 6-7% of people under the age of 18 all around the world.
In the United States, where extensive research has been done, the prevalence of ADHD was found to be 9.1% in children and 4.4% in adults. In India the prevalence rate is very difficult to ascertain due to a lack high quality data. One can assume that it is similar in general terms to other countries, this is certainly evident in our clinical work.
There has been a lot of confusion regarding the existence of ADHD in adults even amongst doctors and mental health professionals. It was assumed by the scientific world that children grow out of it as they become adults. It is becoming increasingly evident that the nature of symptoms get modulated with age, for instance hyperactivity metamorphosises into inner restlessness and impatience. The tendency to be distractible and have a monkey mind persists throughout life.
What Causes It?
Generally, the specific origin of most ADHD cases is unknown. ADHD can surface due to multiple causes. Genetics have the most evidence base—twin, family and adoption studies show that there is a strong connection between ADHD and genetics. Twin studies confirm that ADHD is commonly inherited from the person’s biological parents, with genetics contributing to about 75% of ADHD cases in children.
Another view suggests that the evolution of mankind may have played a role in the high rates of ADHD, particularly in the impulsive and hyperactive traits of men. ADHD traits may have been useful for individuals, by providing better hunting skills or a quicker response time to react to predators. ADHD might have also improved the survival chances for the native man. Theories suggest that the increased frequency of ADHD traits such as impulsivity in the gene pool (a collection of all different genes in a given population) may be due to the fact that women are more attracted to men who are ‘risk takers’. Despite all this, there is no conclusive proof that evolution played a part in ADHD manifestation.
100% of ADHD cases are not caused by genetic factors. Non-inherited or environmental factors may also play a part in the causation of ADHD, although genetic factors play the biggest role. Environmental factors affecting brain development or leading to brain injury have been implicated in ADHD pathogenesis.
Contrary to popular belief, research suggests that factors like bad parenting, poverty and watching too much television and eating too much sugar do not cause ADHD.
Management Of ADHD
The management of all mental health issues is a complex process. Ideally, ADHD should be managed by a multi-disciplinary team comprising of psychiatrists, psychologists, occupational therapists and psychiatric social workers. The psychiatrist needs to use standardised assessment tools to get a holistic overview of the individuals functioning.
Once the diagnosis is clearly established, then the psychiatrist has to determine whether psychostimulant medications such as methylphenidate are indicated. From an evidence-based perspective, psychostimulant medications have robust data to prove their effectiveness. The psychiatrist has to assess the risk-benefit ratio to determine the above.
The clinical psychologists have to undertake behavioural modification sessions with the individual, and with parents and the family members. Behavioural modification entails using cognitive behavioural therapy principles to bring about a positive change in the symptoms of ADHD. Occupational therapists need to undertake tolerance enhancing sessions on top to help the individual in reducing their restlessness, inattention and impulsiveness. They can also help structure the constructive activities such as aerobic and creative activities. Psychiatric social workers can help with family therapy interventions.
Research suggests, only three treatments have shown effectiveness in combating ADHD. The first is that of behaviour modification, the next one involves the use psychostimulants and other related medications and the last one is a combination of the first two. Each of these three interventions has been shown to be effective in the short term, with psychostimulants reducing the symptoms around 80% of the time .
Prognosis or outlook
ADHD is a disorder without a set cure or remedy; hence its prognosis is variable. At least 70% of ADHD cases persist into adulthood, meaning that the symptoms never completely go away. Individuals develop their own coping mechanisms to manage their symptoms in unique ways, through lifestyle changes.
There are several studies looking at the long term consequences of not recognising and treating ADHD. There is strong evidence that it leads to negative outcomes academically, vocationally and personally. Including higher rates of obesity and modern day physical health problems like diabetes, hypertension and heart disease. Appropriate and judicious management of ADHD can lead individuals gaining an upper hand on the disorder and learn to reduce its negatives, thus optimising their quality of life.
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