ADHD stands for attention deficit hyperactivity disorder. It is an attention disorder in which a person is unable to focus or pay attention to an activity. Other signs include hyperactivity and impulsivity. These symptoms inhibit a person’s normal functional capabilities and mental development. The symptoms may begin to appear from the age of six to twelve. In children, these conditions usually lead to bad performance at school and may also cause problems in other areas such as co-curricular activities. The exact cause for this condition is still unknown even though it is a very common condition in modern society. It is more common in boys than girls.
According to the world health organization, Attention Deficit Hyperactivity Disorder, or ADHD henceforth, affects every nation equally and the numbers are close to 40 million people every year. ADHD is a serious condition. It causes a person to wander off important tasks and be inconsistent. This happens when a person shows signs of inattention. ADHD presents in three main forms. People who have inattention, people who have hyperactivity or impulsivity, and lastly, people who have both. Hyperactivity is when a person can’t stay still for longer periods of time. They have a tendency to move around constantly and are generally restless. Fidgeting, talking constantly and excessive amounts of activities under inappropriate situation also come under hyperactivity.
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When a person makes swift and hasty decisions without giving those situations much thought, they are said to have acted on an impulse. This is quite normal under extreme life or death situations or where swift decisions are mandatory and a person acts based on his instinct. When a person is suffering from ADHD, he makes most of the day to day decisions in a split second without contemplating their consequences or how it might affect others and the future. This tendency, known as impulsivity, very often results in difficult situations and might even cause the person suffering from it to create harmful situations for himself and others as well.
ADHD Symptoms and Signs
Inattention is a very broad term and is sometimes overlooked by most people. People with this problem often waive it off considering it a simple sign of sleep depravity or just normal laziness. Following are some of the examples of situations and scenarios which might help in recognizing this condition:
• Being careless while doing simple tasks related to school like homework, making small and simple mistakes in school work or other activities like sports and co-curricular activities also points towards inattention.
• Losing the train of thoughts very often and easily and often ignoring people talking to you.
• Problems in paying attention to people talking to you or in lectures at school.
• Loosing concentration while studying or playing games.
• Loosing focus while reading a large book or article.
• Tendency to forget the instructions received in school or work or both and unable to follow through on them.
• 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 sidetracked.
• People with managing jobs or performing tasks that require some foresight thinking, often find it very difficult to keep track of what to do next or what task comes after the current step as they lose focus.
• The time management skills are severely affected.
• Tend to avoid or postpone the tasks that require considerable amount of thinking or mental strength. These tasks can range from simple homework to complex work related reports or review papers as well that require long sessions of reading and noticing.
• Carelessness regarding personal belonging which are necessary for school or work such as stationary items, books, notepads, wallets, keys, tools, glasses, cell phones, important papers etc.
• Get distracted pretty easily and very often by simple thoughts or other environmental or visual stimuli.
• Forgetting routine things like daily chores, calls and appointments.
Hyperactivity and impulsivity symptoms and signs show together. These can be identified better by looking at the following examples:
• People with hyperactivity tend to fidget with their hands and squirm or move restlessly in their seats.
• They tend to vacate their seats in important events such as a function or in the classroom where they are not expected to leave their positions.
• Children with hyperactivity ADHD tend to run and climb in areas where they are not allowed or it’s not appropriate like halls or stairs.
• They usually can’t hold on to a specific hobby or sports and tend to keep changing their fields of interests.
• They always seem to be charged up and filled with extraordinary energy.
• They tend to talk nonstop and excessively, wearing out the people listening to them.
• They are so impatient that they speak out of turn and unexpectedly even when people are not addressing them.
• They answer a question which was either not meant for them or before the question has even been completed.
• They finish other people’s sentences which is socially awkward.
• In games, sports or long queues, they have a very hard time waiting for their turn. They keep squirming and fidgeting impatiently in their spots.
• They often interrupt others while in a conversations or playing sports.
ADHD can be diagnosed by a licensed doctor with a specialty in ADHD. These include pediatricians. Psychologists and psychiatrists. In children, the symptoms start appearing in the ages between three years and six years. The symptoms of hyperactivity/impulsivity or inattention should be consistence and chronic. The doctors also make sure that these symptoms are not caused by any other medical condition like clinical depression. These symptoms must also interfere or affect the child’s development or performance to qualify for ADHD. In cases where an adult is diagnosed with ADHD, usually, the symptoms are present before the age of twelve.
Generally speaking, as is the case in Indian society, people often mistakes the symptoms of inattention to laziness or emotional problems. Some parents or guardians even try to cure this symptoms by “disciplining” the child one way or another. When a child behaves aloof and prefers solitude, people take it for serious or calm behavior and wave it off as a personality trait. These common mistakes lead to a considerable delay in diagnosing the condition.
In due course of time, the symptoms of ADHD can change. While in children, the most common symptom is hyperactivity/impulsivity, as the person becomes older, the symptoms can change to inattention. In elementary stages, the hyperactivity is replaced by inattention which becomes clear by poor academic performance. In teen years, symptoms like fidgeting and restlessness become prominent and may lead to antisocial behaviour and failed relationships. Poor relationship records might indicate some other psychological issues like trust problems and insecurity.
As stated earlier, there’s no known cause of this condition so far but scientist have succeeded in coming up with a number of risk factors which might make a person or child susceptible to ADHD.
Genes: 75% of the people who have been diagnosed with ADHD have been confirmed with parents who carry the same genes directly responsible for ADHD. This was determined by twin studies. Also, people whose sibling have been diagnosed with ADHD are thrice more likely to show the signs of ADHD than those whose sibling don’t have it. Genes also determine how long this disease persists and whether it passes into adulthood.
The environmental factors that contribute to this condition are alcohol intake during pregnancy, exposure to lead, polychlorinated biphenyls, insecticides, tobacco and cigarette consumption during pregnancy. Most of these factors affect the neural development of the child or fetus. Apart from these, low birth rate, premature delivery, physical or mental abuse, certain infections during childbirth or pregnancy like measles and finally people who suffer brain injury.
in some cases, ADHD is found to be more of a social problem than an individual one. This is because of a poor educational system or a dysfunctional family where very high expectations are demanded of the children. Children have behavioral symptoms of ADHD if they have suffered emotional or physical abuse.
The social construct theory of ADHD:
According to this theory, the difference between normal and abnormal behavior is created by the combination of teachers, parents and doctors. Based on these principles of normality, a suitable method for the diagnosis of ADHD is applied. Different methods are used based on different notions of what normal and abnormal behaviour is and this difference affects the total number of people who are considered to be diagnosed. Common notions among people regarding the causes of ADHD are watching too much TV, eating excessive sugar, bad parenting, poor living conditions etc. Although, they are not the causes, but they do worsen the condition.
There is no cure for ADHD, but it can be managed with medications and counselling. These can be used wither alone or in combination with the other. The combination can prove effective for longer terms, but there are negative effects of the medications which are caused by the inclusion of antidepressants, atomoxetine and some stimulants as part of the treatment.
This kind of treatment is the most preferred and widely recommended in people who have mild symptoms. These are basically psychological treatments and counselling sessions in which certain activities and brain exercises are included. Some of the psychological therapies are psycho-educational input, cognitive behavioural therapy, organization training, interpersonal phsychotherapy, family therapy, social skills training, school counselling, neurofeedback, parental management training etc.
Behavioral parent management training
This is a program in which the parents are taught the skills which they might need in order to encourage positive behaviours in children. This can be done on a positive reinforcement basis where every improvement stage is rewarded with a prize. This is more efficient if the feedback that is given to the child on his performance is immediate, whether it is positive or negative. If the result of a certain task is not favorable, the parents can choose to either ignore it or help the child to learn the correct way to do something. When a certain behavior is deemed bad, the parents can discourage that behavior, parents are also taught to plan or craft certain artificial situations in order to train the child for the desired results.
Along with the patients, the parents or guardians of the children with ADHD are also deeply affected. Caring for their children can get really frustrating and tiresome. Therefore, stress management therapy is recommended for the parents so that they can deal with it better and help their children with their condition as best as they can. Apart from this, parents and the families of the patients can also attend support groups in which other families who have a family member suffering from this condition share their feelings and lighten their burden by talking about various problems in a safe zone. Group sessions are also a good place for them to trade information like tricks and tips for better care of the children and also share information about different medications and experiences with different physicians.
Aerobic exercise if done consistently have shown better results when used in combination with stimulant medications. Patients have displayed better physical and motor skills, faster processing speed, better executive function, better planning capabilities and reduced levels of anxiety and restlessness.
There are mainly two kinds of medications that are used for the treatment of ADHD, stimulants and non-stimulants. Non stimulant medications are atomoxetine, bupropion, guanfacine, and clonidine which are used in combination of stimulant medications. Studies show that stimulant medications are more likely to improve academic performance as compared to non-stimulus medications like atomoxetine. Still, atomoxetine has its own benefits in a way that it is non-addictive. It is preferred in cases where patients are likely to fall prey to recreational use. These medications are considered safe but there are still side effects. If the stimulus medications are used in excess, the patient can develop stimulant psychosis and mania. Therefore, regular monitoring and checkups are mandatory so that the physician can alter the medications if required.
Common side effects of stimulus medications are:
• A decreased appetite.
• Problems in sleeping
• Tics, which is a sudden and repetitive movement.
• Noticeable changes in the patient’s personality.
• An increase in irritability and anxiety levels.
• Pain in the abdomen.