ADHD: Causes, Symptoms, and Treatments

Definition 

ADHD is a brain disorder that interferes with both the functioning and normal development of a person, and is characterized by inattention and hyperactivity impulsivity (Nigg & Song, 2018). The condition is prevalent among children and tends to stay throughout their development phases to adulthood, unless treated. Inattention is characterized by the inability of the individual to remain focused, and not as a result of lack of comprehension. Hyperactivity is mostly portrayed from the patient’s lack of settlement in one area or spot; they move around constantly and are often restless, while impulsivity has to deal with hasty decision making without thinking about the possible consequences associated by taken actions. 

Possible Etiologies 

ADHD has different etiologies, which are influenced by a portfolio of environmental factors, genetic factors, and neurological factors, or just individual factors from the portfolio. These factors affect the pathogenesis of the disorder, hence exhibiting the heterogeneous phenotype. 

ADHD can be transmitted from a parent to an offspring genetically, thus making it a polygenic disorder. Gene variants associated with the risk for ADHD are essential for brain development, encoding for transporter genes, catecholamine receptors, and other neurotransmitter pathways in the human brain. In ADHD patients, these gene variants either undergo massive deletion, accumulation, or duplication (Sciberras et al., 2017). 

However, there exist other factors that affect the neurological transmitters in the brain, but cannot be passed from parent to offspring. For instance, brain injuries such as traumatic injuries, and Hypoxic-anoxic injuries distort the functioning of the brain and may lead to ADHD complications, pregnancy complications, exposure to tobacco and alcohol by pregnant mothers may affect the baby’s brain, epilepsy, and in some cases low birth weight. 

Environmental factors are also key players in the prevalence of ADHD among both children and adults. Environmental toxins such as lead, pesticides, and polychlorinated biphenyls are examples of causative agents of ADHD. Children experiencing early deprivation, psychosocial adversity, and a tough family environment are also prone to suffer ADHD. 

Volumetric and MRI studies indicate that distortion of early brain development in a child is a major cause of ADHD: structural development differences and functional activation of the basal ganglia, cerebellum, cortex, and the anterior cingulate cortex are the primary factors. For instance, delayed cortical maturation, cortex thickness in the cerebellum mark the beginning of ADHD development in children between the age of seven and ten years. Brain activities in these regions are influenced by the catecholamine receptors. Therefore, most treatment options are directed towards modulating neurotransmitters and the catecholamine. 

Signs and Symptoms 

ADHD patients exhibit symptoms for the disorder under three categories, from the definition of the condition: inattention, hyperactivity, and impulsivity. However, if a person shows some of these signs and symptoms, it does not necessarily mean that they are suffering from ADHD, but they should consider seeing a doctor or a health profession in neurology 

Inattention 

ADHD patients tend to miss details during events and activities at work, in school, or other activities that they might be involved in. 

Inability to maintain focus in performing tasks assigned, reading, studying, and also when involved in conversations with other people. 

Failure to listen when spoken to directly, and usually not out of ignorance, nor rudeness. 

Failure to follow instructions to the core and complete tasks and assignments due to easy distraction from the course. 

Showing problems with proper organization of work, arrangement of items and material in a sequence or neatly, meeting deadlines, and time management. 

Showing dislike for tasks that require mental commitment such as school work, report writing and review, lengthy reading, and completion of forms and surveys. 

Losing items unnecessarily, and carelessness in handing situations and storing material. 

Hyperactivity and Impulsivity 

Excessive talking without a break at any point in the conversation. 

Fidgeting while seated. 

Moving around when it is expected that they should be seated. 

Restlessness. 

Completing other people’s sentences, answering without listening first. 

Impatience in waiting for their turn. 

Diagnosis and Prognosis 

The diagnosis of ADHD faces a lot of challenges due to lack of enough biological markers that indicate manifestation of the disorder in an individual. DSM-5 is the most popular criteria used to diagnose ADHD. The criteria checks that the multiple phenotypes are prevalent in an individual’s daily activities. However, among preschool children, DSM criteria cannot be used, but rather parental tools and observations. Parents to children who have not yet reported to school are given a special training that helps them identify consistency in exhibition of certain characteristics associated with ADHD among their children. 

Behavioral observation from teachers and parents plays an important role in diagnosis of ADHD among teenagers and children between the age of 7 and 10 years. Once strange behavior is noted with a child, a medical expert should examine the case as part of the diagnosis process. The medical expert obtains development history of the individual and puts it on assessment for language, motor, social milestones, and emotional attachments. Additionally, family mental health history is also evaluated amid assessment for comorbid disorders, both psychiatric and neurological; academic report cards, and sample assignments. Based on the results of the assessment, the expert should certify that the symptoms are severe and persistent, adaptability skills are lacking, discrepancies, the type of ADHD; whether combined presentation, predominant inattentive, or predominant hyperactive-impulsive presentation, and finally the severity. 

Treatment and Intervention 

ADHD has no cure, but there exist treatment remedies that reduce the signs and symptoms of the disorder. The disorder is mostly treated by combining medication, education, therapy, and training. 

Medication 

Medication reduces the hyperactivity and impulsivity of the patient, and boosts the ability of the patient to maintain focus and attention. Medications for ADHD can be categorized into three groups; anti-depressants, stimulants, and non-stimulants (Bergi et al., 2018). Stimulants increase dopamine levels in the brain, thus enhancing attention levels and focus; anti-stimulants also act the same way as stimulants except that they are used if stimulants have negative side effects to the patient. Antidepressants are effective in adults with ADHD complications due to their effect on dopamine and norepinephrine levels in the brain. 

Therapy 

Therapy can be primary in controlling the symptoms of the ADHD disorder, but cannot be solely relied upon to fully suppress ADHD. However, using therapy alongside medication has proved effective in many ADHD cases in the US. 

Training and Education 

Parents and teachers can train and educate children to follow set timetables and routine guides every day, with a promise of reward on accomplishment. This technique helps the child develop a habit with sustaining focus in daily activities thus suppressing inattention. For adults with ADHD, medical experts can help them establish these routines. 

Preventive Measures 

ADHD preventive measures are mainly centered on early child development and upbringing, and rests solely on the shoulders of the parents, and teachers. The mother should stay healthy during the pregnancy period; avoid alcohol and other drugs, eat a balanced diet, and exercise (NCCMH, 2018). 

Children should also be put on dietary observation; foods that tend to affect their behavior should be cut off, while ensuring that a balanced diet is maintained at the end of the day. Additionally, the home environment should be set to be conducive for child upbringing; avoiding violence is among a step that can establish a good parent and child relationship. 

Structured routines can also impact on preventing prevalence of ADHD in children. For instance, setting a routine that involves waking up, taking meals, playing, homework, chores, television, family time, and bed will help with attention and order. 

African Americans kids living with ADHD 

Previous studies by the journal of attention disorders infer that African American children are more likely to display ADHD symptoms relative to children from other racial and ethnic carders. The research indicated that ADHD cases were more prevalent on African American boys who are said to receive higher score on ADHD assessment measures in comparison with Caucasian boys. The condition affects the children’s IQ and ability to function in school owing to less cognitive function. ADHD adversely impacts the low income earning community by causing family disturbances as well as curtailing proper marital functioning in such households. 

Summary of a Case 

A case of a forty two year old mother suffering from ADHD, since her childhood. The patient has two children in their adolescent stage, and her marriage is falling apart. The patient’s history indicate inconsistency at school, inattention, and disorderliness. Additionally, her home is a mess and most times the family members have to help her find her keys and wallet before she reports to work, albeit the husband preparing a clear schedule for the family. The patient has also been losing her jobs due to tardiness, disorderliness, lateness, and harsh criticisms of her superiors. The doctor diagnoses the patient and settles on atomoxetine treatment drugs, which the patient responds to better; her emotions are well handled, she considers quitting smoking, and her marriage improves within a few months of assessment and monitoring by the doctor. The lady sets up a plan to help her minimize distractions such a small office with a door, key finders, checklists, and also goes for training on scheduling and time management. The patient does well in her new job in sales (Medscape, 2019). 

Prevalence Statistics 

Table 1. ADHD prevalence among children in USA 

Source : National Survey of Children Health (NSCH), 2003-2011 

References 

Bergey, M. R., Filipe, A. M., Conrad, P., & Singh, I. (Eds.). (2018).  Global perspectives on ADHD: social dimensions of diagnosis and treatment in sixteen countries . JHU Press. 

Medscape, 2019. Attention-Deficit Hyperactivity Disorder; two case studies. Retrieved from, https://www.medscape.org/viewarticle/513743_14 

National Collaborating Centre for Mental Health (UK. (2018). Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults. British Psychological Society. 

Nigg, J. T., & Song, M. (2018). ADHD and early experience: Revisiting the case of low birth weight.  Pediatrics ,  141 (1), e20173488. 

Sciberras, E., Mulraney, M., Silva, D., & Coghill, D. (2017). Prenatal risk factors and the etiology of ADHD—review of existing evidence.  Current psychiatry reports ,  19 (1), 1.