The disorder attention deficit hyperactivity disorder (ADHD) is one of the development disorders more common in children and may continue into adolescence and adulthood. It is characteristic of people who move from one activity to another, who start several tasks without finishing any, and who seem not to pay attention if others speak.
Its main symptoms are hyperactivity, inattention and impulsivity. Hyperactivity is shown by doing multiple activities, not stopping to move, going from one activity to another, inability to stay still, among others. Lack of care for Difficulty paying attention to people who are talking or performing tasks. The Difficulty controlling impulses, acting without thinking.
Children’s hyperactivity and inattention at school can lead to academic deficiencies and problems in personal relationships. Brain imaging studies have found that in children with ADHD, the brain matures in a normal pattern, albeit with an average delay of about 3 years.
This delay occurs more in brain areas related to attention, planning or thinking. Other recent studies have found that there is a general delay in maturation in the cerebral cortex.
Although treatments can alleviate symptoms, there is currently no cure. With treatment, most children can be successful in school and lead productive lives.
Adults with ADHD
Usually adults with ADHD have had the disorder since childhood, although it has not been diagnosed until adulthood. The evaluation usually occurs from a colleague, friend or family member who has observed problems at work or in personal relationships.
The symptoms of adults may be somewhat different from those of children because there is a difference in maturity and physical differences.
Myths about ADHD
All children with ADHD are hyperactive
Some children with this disorder are hyperactive, while others with attention problems are not. Children with ADHD who have attention problems but are not over-aroused may appear unmotivated.
Children with ADHD can’t pay attention
Children with ADHD can focus on the activities they enjoy. However, they have trouble maintaining focus when homework is boring and repetitive.
Children with ADHD could behave better if they wanted to
Children with ADHD can do their best to be good, even though they are unable to sit, stay still, or pay attention.
When they grow up, children stop having ADHD
ADHD normally continues into adulthood, although treatment helps control and minimize symptoms.
Medication is the best option
Although medication is often prescribed, it may not be the best treatment for a child. Effective treatment also includes education, behavior therapy, exercise, proper nutrition, and school and family support.
Is It Really Attention Deficit Hyperactivity Disorder?
Just because a child is inattentive, hyperactive, or impulsive doesn’t mean they have ADHD. Other medical conditions, psychological disorders, and stressful events can cause similar symptoms.
Before a clear diagnosis of ADHD can be made it is important that a healthcare professional evaluate other possibilities:
- Learning problems : reading, writing, motor skills or language.
- Traumatic experiences : bullying, divorces, death of loved ones …
- Psychological disorders : depression, anxiety and bipolar disorder.
- Behavioral disorder : for example defiant disorder.
- Medical conditions : thyroid problems, neurological conditions, epilepsy, and sleep disorders.
Positive effects associated with ADHD
In addition to the challenges they encounter, there are positive traits associated with people with ADHD:
- Creativity : Children with this disorder can be very creative and imaginative. Children who have hundreds of thoughts can create sources of ideas to solve problems. Although they are easily distracted, they can notice things that others do not see.
- Flexibility : Children with ADHD consider many options at once and are open to more ideas.
- Enthusiasm and spontaneity : Children with ADHD are interested in many different things and are active.
- Energy : Children with ADHD can work hard if they are motivated. If they are interested in a task, it is difficult to distract them from it.
Note: ADHD is not related to talent or intelligence. However, there may be children in whom high intelligence and ADHD coincide.
Characteristic behaviors of people with ADHD are inattention, hyperactivity, and impulsivity. Although it is normal for children to display these behaviors, those with ADHD have more severe symptoms and they are common.
Symptoms of inattention
- Being easily distracted, not paying attention to details, forgetting things and moving quickly from one activity to another.
- Have a hard time focusing on one thing.
- Getting bored with a task only after a few minutes, unless they do something they enjoy.
- Having trouble completing tasks.
- They seem not paying attention.
- “Daydreaming,” moving slowly, or easily confused.
- Having difficulties processing the information.
- Trouble following directions.
Symptoms of hyperactivity
- Move without stopping in the seats.
- Talk nonstop.
- Walking, touching and playing with anything.
- Having trouble sitting down to do normal activities.
- Be constantly moving.
- Having difficulty doing quiet activities.
Symptoms of impulsivity
- Be impatient.
- Say inappropriate comments.
- Act without thinking about the consequences.
- Interrupt conversations or other activities.
Although the cause of most cases of ADHD is unknown, it is believed to be related to interactions between genetic factors and environmental factors.
Some cases may be due to previous infections or brain trauma.
Twin studies indicate that the disorder is inherited from the parents, accounting for 75% of cases. Siblings of children with ADHD are estimated to be 3-4 times more likely to develop it.
It is also believed that certain genetic factors determine whether the disorder persists into adulthood.
Several genes are involved, many of which affect dopaminergic neurotransmission: DAT, DRD4, DRD5, TAAR1, MAOA, COMT, and DBH. Others are: SERT, HTR1B, SNAP25, GRIN2A, ADRA2A, TPH2, and BDNF. It is estimated that a variant of the gene called LPHN3 is responsible for 9% of cases, and that when this gene is present, the person responds to stimulant medication.
Because ADHD is common, it is likely that natural selection has favored these traits and that they have given a survival advantage. For example, some women may be attracted to men who take risks, increasing the frequency of gene transmission.
Because ADHD is more common in children with anxious or stressed mothers, it has been argued that it may be an adaptation that helps children cope with dangerous or stressful environments, with increased impulsivity and exploratory behavior.
Hyperactivity may have been beneficial from an evolutionary perspective in situations of risk, competitiveness, or unpredictable behavior (for example to explore new areas or explore new resources).
In these situations, people with ADHD can be beneficial to society, even though it may be harmful to the individual.
On the other hand, individually it may have offered advantages such as responding more quickly to predators or having better hunting skills.
Environmental factors are believed to play a less important role in the development of ADHD. Drinking alcohol during pregnancy can lead to fetal alcohol syndrome, which can include symptoms similar to ADHD.
Exposure to tobacco during pregnancy can cause problems in the development of the fetal central nervous system and can increase the risk of ADHD. Many children exposed to tobacco do not develop ADHD or have only intermediate symptoms, which is not enough for a diagnosis.
A combination of genetic predisposition and some factors such as negative exposures during pregnancy can explain why some children develop ADHD and others do not.
Children exposed to chlorine, even at low levels, or to polychlorinated biphenyls can develop ADHD-like problems. Exposure to organophosphate insecticides chlorpyrifos and dialkyl phosphate is associated with an increased risk, although there is no conclusive evidence.
Low birth weight, premature birth, or infections during pregnancy, birth, and early childhood also increase the risk. These infections include various viruses – measles, chickenpox, rubella, enterovirus 71 – and streptococcal bacterial infection.
At least 30% of children with brain injury develop ADHD and 5% are due to brain damage.
Some children may react negatively to food coloring or preservatives. It is possible that some dyes may act as triggers for ADHD in children who are genetically predisposed.
ADHD can represent family or educational system problems rather than an individual problem.
Younger children in classes have been found to be more likely to be diagnosed with ADHD, possibly due to developmental differences from their classmates.
ADHD behavior occurs more often in children who have experienced emotional or physical abuse. According to the theory of social construction, it is society that determines the boundaries between normal and abnormal behavior.
The members of a society – parents, teachers, doctors – determine what diagnosis and criteria are used, thus affecting the number of people affected.
This leads to situations like the current one, in which from the DSM-IV diagnosis, 3-4 times more cases of ADHD are diagnosed than with the ICE-10 criteria.
Some psychiatrists, like Thomas Szasz, have argued that ADHD was invented, not discovered.
Current models of ADHD suggest that it is related to functional alterations in some neurotransmitter systems in the brain, particularly dopamine and norepinephrine.
The dopamine and noreprinefin pathways originate in the ventral tegmental area and at the locus coeruleus they project to various brain regions of the brain, controlling various cognitive processes.
The dopamine and noreprinephrine pathways that project to the prefrontal and striatum cortex control executive function (cognitive control of behavior), perception of rewards, and motivation.
Psychostimulants may be effective because they increase neurotransmitter activity in these systems. In addition, there may be abnormalities in the cholinergic and serotonergic pathways. Glutamate neurotransmission also appears to play a role.
There is a reduction in the volume of certain brain regions in children with ADHD, especially in the left prefrontal cortex.
The posterior parietal cortex also shows thinning in children with ADHD.
Motivation and executive functions
The symptoms of ADHD are related to difficulties in executive functions; mental processes that control and regulate daily tasks. The criterion for a deficit in executive functions occurs in 30-50% of children and adolescents with ADHD.
Some problems are with time control, organization, procrastination, concentration, information processing, emotion control or working memory .
One study found that 80% of people with ADHD had problems with at least one executive function, compared to 50% of people without ADHD.
ADHD has also been linked to motivational deficits in children, as well as difficulties focusing on long-term rewards. In these children, higher positive rewards improve task performance. Additionally, stimulants can improve persistence.
ADHD-like and related disorders
Two out of three times another disorder occurs alongside ADHD in children. The most common are:
- Tourette syndrome.
- Learning Disorders: Occur in 20-30% of children with ADHD.
- Oppositional Defiant Disorder: Occurs in approximately 50% of children with ADHD.
- Conduct disorder: occurs in approximately 20% of children with ADHD.
- Primary alertness disorder: it is characterized by problems staying awake and poor concentration and attention.
- Sensory overstimulation: it is present in less than 50% of people with ADHD.
- Mood disorders (especially depression and bipolar disorder).
- Anxiety disorders.
- Obsessive compulsive disorder
- Substance abuse in adolescents and adults.
- Restless legs syndrome.
- Sleep disorders.
- Delay in language development.
Current therapies focus on reducing ADHD symptoms and improving functioning in daily life. The most common treatments are medication, various types of psychotherapy, education, and a combination of various treatments.
Stimulants such as metalphenidate and amphetamines are the most commonly used types of medication to treat ADHD.
It may seem counterintuitive to combat hyperactivity with a stimulant, although these drugs activate regions of the brain that improve attention, reducing hyperactivity. Additionally, non-stimulant medications such as atomoxetine, guanfacine, and clonidine are used.
However, it is necessary to find the medication for each child. One child may have side effects with one drug, while another may benefit. Sometimes it is necessary to use several doses and types of drugs before finding one that works.
The most common side effects are sleep problems, anxiety, irritability, and decreased appetite. Other less common side effects are tics or personality changes.
Medication does not cure ADHD, but rather controls symptoms while taking it. Drugs can help your child focus or learn better.
Different types of psychotherapy are used to treat ADHD. Specifically, behavioral therapy changes behavior patterns by:
- Reorganize the school and home environment.
- Give clear orders.
- Establish a system of consistent positive and negative rewards to control behaviors.
Here are some examples of behavioral strategies:
- Organize : put things in the same place so that the child does not lose them (school objects, clothes, toys).
- Create a routine : follow the same schedule every day, from the time the child gets up until he goes to bed. Post the schedule in a visible place.
- Avoid distractions : turn off radio, TV, telephones or computers when the child is doing homework.
- Limit options : have the child have to choose between two things (food, toys, clothes) to avoid overstimulation.
- Use goals and rewards : use a sheet on which to write the goals and the rewards obtained if they are achieved. Make sure the goals are realistic.
- Discipline : for example, that the child loses privileges as a result of bad behavior. Younger children can be ignored until they show better behavior.
- Finding leisure activities or talents : Finding what the child is good at – music, art, sport – to build self-esteem and social skills.
Children with ADHD need the guidance and understanding of parents and teachers to reach their potential and be successful in school. Frustration, blame, or hatred may build in the family before a child is diagnosed.
Health professionals can educate parents about ADHD, train skills, attitudes, and new ways of relating. Parents can be trained to use reward and consequence systems to modify the child’s behavior.
Sometimes the whole family may need therapy to find new ways to deal with problem behaviors and to encourage behavior changes.
Finally, support groups can help families connect with other parents with similar problems and concerns.
There is little research to indicate that alternative therapies can reduce or control ADHD symptoms. Before using any of them, ask a mental health professional if they are safe for your child.
Some alternative therapies are:
- Diet: eliminate foods such as sugar or possible allergens such as milk or eggs. Other diets recommend eliminating caffeine, colorants, and additives.
- Herbal supplements.
- Vitamins or supplements.
- Essential fatty acids:
- Yoga or meditation.
ADHD at school
Here are some tips for classes with kids with ADHD:
- Avoid distractions : for example, by sitting the child near the teacher instead of near the window.
- Use a homework folder : include progress and notes to share with parents.
- Dividing tasks : dividing tasks into clear and small parts for children.
- Give positive reinforcement : encourage or give some reinforcement when the child behaves appropriately.
- Supervision : checking that the child goes to school with the correct books and materials.
- Promote self-esteem : avoid having the child do difficult activities in public and encourage when they do things well.
- Teach study skills .
Because ADHD is unique to each child, it is difficult to make recommendations that work for everyone. However, some of the following recommendations may help to better control symptoms:
- Show affection : Children need to hear that they are appreciated. Focusing only on the negative aspects of the behavior can damage the relationship and affect self-esteem.
- Sharing free time : One of the best ways to improve acceptance between parents and children is to share free time.
- Build self-esteem : Children with ADHD tend to do well in artistic, musical, or sports activities. Finding a child’s special talent will improve her self-esteem.
- Organization : help the child keep a diary of daily tasks. Also, tidy up the workplace so you don’t have distractions.
- Give directions : use simple words, speak slowly, and give specific orders.
- Establish schedules : establish sleep routines and activities, in addition to using calendars to mark important activities.
- Breaks : Fatigue and tiredness can make ADHD symptoms worse.
- Identify situations : avoid difficult situations for the child such as sitting in long presentations, going to supermarkets or boring activities.
- Be patient : try to remain calm even when the child is out of control.
Complications in children’s lives can be:
- Difficulties in school.
- Tendency to have more accidents and injuries.
- Possibility of having worse self-esteem.
- Problems interacting with other people.
- Increased risk of alcohol or drug use.
Risk factors can be:
- Family members with ADHD or another mental disorder.
- Exposure to environmental toxins.
- Use of alcohol or drugs by the mother during pregnancy.
- Exposure of the mother to environmental toxins during pregnancy.
- Premature birth.
To reduce the chance of a child developing ADHD:
- During pregnancy: avoid harm to the fetus, avoid alcohol, tobacco and other drugs. Avoid exposure to environmental toxins.
- Protect the child from exposure to environmental toxins such as tobacco or industrial chemicals.
- Limit exposure to screens: Although it has not been proven, it may be prudent to avoid excessive exposure of the child to TV or video games during the first five years of life.
ADHD and its diagnosis have been controversial since the 1970s. Positions range from viewing ADHD as normal behavior to the hypothesis that it is a genetic condition.
Other areas of controversy include the use of stimulant medications in children, the manner of diagnosis, and possible overdiagnosis.
- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing. pp. 59–65. ISBN 0890425558.
- National Institute of Mental Health (2008). “Attention Deficit Hyperactivity Disorder (ADHD)”. National Institutes of Health.
- Sand T, Breivik N, Herigstad A (February 2013). “[Assessment of ADHD with EEG]”. Tidsskr. Nor. Laegeforen. (in Norwegian) 133 (3): 312–316.