Attention Deficit Hyperactivity Disorder: Symptoms and Treatment

Attention Deficit Hyperactivity Disorder or ADHD is a behavioral developmental condition leading to restlessness and poor attention span. The disorder is primarily diagnosed in childhood, although adults also frequently suffer from it. The prevalence of ADHD in children of school-going age is about 7.2%, making it among the most common conditions affecting childhood. Boys experience symptoms more commonly than girls at a 4:1 ratio.

In adults, the prevalence is about 3.4% as per the WHO world mental health survey in 2007. Adults often have other psychiatric illnesses associated with ADHD such as mood disorders, anxiety, and substance use disorders.

Causes of ADHD

The exact underlying cause is unknown and several theories are in place regarding the mechanism of ADHD.

• Genetic factors: It has been found that ADHD runs in families and may be inherited. In addition, several genes have been associated with ADHD.
• Environmental factors such as dietary habits and iron or zinc deficiency may play a role. The home environment and parenting practices can also affect a child’s behavior
• Biochemical imbalances in the brain: Rat models suggest that relative imbalance in dopamine and noradrenaline in the brain contributes to ADHD.

Symptoms of ADHD

• Feeling of restlessness and desire to run around
• Excessive movement
• Inability to sit for long periods to complete any work
• Difficulty remaining quiet with excessive talking
• Interrupting others and tendency to blurt out answers quickly in educational settings
• Appearing not to listen to instructions
• Easy distractibility
• Poor attention in class or at work
• Poor performance at school or work

Diagnosis of ADHD

The diagnosis is made after a careful evaluation of the individual through the following means before concluding the diagnosis

• Medical evaluation: This includes a detailed history surrounding the birth and development of the individual with attention to family history. A physical examination to look for signs of any congenital mental disorders is carried out along with a complete neurological exam including testing for normal vision and hearing
• Behavioral evaluation: A focussed history of developmental milestones and social behavior is done exploring activities at school and home
• ADHD scales: These scales are filled out by the parents and teachers in school
• Evaluation for associated mental illnesses like anxiety, depression and substance use
• Electroencephalography (EEG)- Quantitative EEG (qEEG) has been shown to aid in the diagnosis of ADHD
• Genetic testing for congenital disorders with intellectual disability
• Additional tests to rule out thyroid problems, lead poisoning, iron or zinc deficiency are done if clinically relevant.

The diagnosis is based on the defined criteria published in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) and is usually made by a qualified psychiatrist

Management of ADHD

ADHD is managed with a combination of medications and behavioral therapy.

Medications: Stimulants such as methylphenidate and amphetamines have been approved for use in ADHD. Atomoxetine is an alternative medication which has also shown benefit

Behavioral Therapy: These include counseling and behavior modification with the training of both parents and children using positive reinforcement, time-out, and withdrawal of privileges. Teachers can also help by making changes to the student’s schedule at school.

Prognosis of ADHD

There is no definitive cure for ADHD but it can be managed well-using medications and behavioral therapy. Long term outcomes are dependent on the initial presentation, intellectual quotient, and the presence of other mental illnesses. Earlier diagnosis and treatment has been found to have improved outcomes.

References:

• Fayyad J, De Graaf R, Kessler R, Alonso J, Angermeyer M, Demyttenaere K, et al. Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry. 2007 May;190:402–9.
• Attention Deficit-Hyperactivity Disorder Information Page | National Institute of Neurological Disorders and Stroke [Internet]. [cited 2018 Jun 25].
• Thomas R. Thomas R, Sanders S, Doust J, Beller E, Glasziou P, Prevalence of Attention Deficit Hyperactivity Disorder: A systematic review and meta-analysis. Vol. 135. 2015.
• Diagnosis of ADHD using DSM-5TM [Internet]. ADHD Institute. [cited 2018 Jun 25].