Attention Deficit Hyperactivity Disorder (ADHD)

The disorder attention deficit hyperactivity disorder (ADHD) is one of the most common developmental disorders in children and may continue into adolescence and adulthood.

It is characteristic of people who move from one activity to another, who begin several tasks without finishing any and who seem not to pay attention if others speak.

Attention-deficit-of-attention-and-hyperactivity disorder

Its main symptoms are:

  • Hyperactivity: do multiple activities, not stop moving, move from one activity to another, inability to stand still…
  • Lack of attention: Difficulty paying attention to people who speak or to perform tasks.
  • Impulsivity: difficulty controlling impulses, acting without thinking.

Attention Deficit Disorder and Hyperactivity

Over activity and inattention of children in 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, but is delayed by about 3 years.

That delay occurs more in brain areas related to attention, planning or thinking.

Other recent studies have found that in the cerebral cortex there is a general delay in maturation.

Although treatments can relieve symptoms, there is currently no cure. With treatment most children can succeed in school and lead a productive life.

Adults with Attention Deficit Disorder and Hyperactivity

Usually adults with ADHD have had the disorder since childhood, although it has not been diagnosed until adulthood.

The evaluation usually occurs from a partner, 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

1-All children with ADHD are hyperactive

Some children with this disorder are hyperactive, although others who do not have attention problems. Children with ADHD who have attention problems but do not have overactive may seem unmotivated.

2-Children with ADHD cannot pay attention

Children with ADHD can focus on the activities they enjoy. However, they have trouble keeping the focus of attention when the task is boring and repetitive.

3-Children with ADHD could behave better if they wanted

Children with ADHD can give their best to be good, although they are unable to sit, stand still or pay attention.

4-When they grow up, children stop having ADHD

ADHD usually continues into adulthood, although treatment helps to control and minimize symptoms.

5-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, behavioral therapy, exercise, proper nutrition, and school and family support.

Is it really Attention Deficit Disorder and Hyperactivity?

Just because a child has a lack of attention, hyperactivity or impulsivity does not mean that he has ADHD.

Other medical conditions, psychological disturbances and stressful events can cause similar symptoms.

Before a clear diagnosis of ADHD can be made, it is important for a health professional to evaluate other possibilities:

  • Learning problems: reading, writing, motor skills or language.
  • Traumatic experiences: bullying , divorce, death of loved ones …
  • Psychological disorders: depression, anxiety and bipolar disorder.
  • Behavioral disorder: eg, defiant disorder.

Medical conditions: thyroid problems, neurological conditions, epilepsy and sleep disorders.

Positive effects associated with ADHD

In addition to the challenges they face, 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. Even if they are easily distracted, they can realize 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.

Symptoms of Attention Deficit Disorder and Hyperactivity

The characteristic behaviors of people with ADHD are inattention, hyperactivity and impulsivity.

Although it is normal for children to show these behaviors, those with ADHD have more severe symptoms and are frequent.

The symptoms of inattention may be:

  • Distracting easily, not looking at details, forgetting things and moving quickly from one activity to another.
  • Having difficulty focusing on one thing.
  • Get bored with a task only after a few minutes, unless you do something you enjoy.
  • Having problems completing tasks.
  • They seem to pay no attention.
  • “Daydreaming”, moving slowly or easily confused.
  • Having difficulty processing information.
  • Problems following instructions.

Symptoms of hyperactivity may include:

  • To move without stopping in the seats.
  • To talk without stopping.
  • Walk, play and play with anything.
  • Having trouble sitting down to do normal activities.
  • Being constantly moving.
  • Having difficulty doing quiet activities.

Symptoms of impulsivity may be:

  • Be impatient.
  • Inappropriate comments.
  • Act without thinking about the consequences.
  • Interrupt conversations or other activities.

Causes

Although the cause of most ADHD cases is unknown, it is believed to be related to interactions between genetic factors and environmental factors.

Some cases may be from previous infections or from brain trauma.

Genetic factors

Studies with twins indicate that the disorder is inherited from parents, accounting for 75% of cases.

It is estimated that siblings of children with ADHD are 3-4 times more likely to develop it.

It is also believed that certain genetic factors determine whether the disorder persists during 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 given an advantage for survival.

For example, some women may be attracted to men who take risk, 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 greater impulsiveness 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, individual may have offered advantages such as responding more quickly to predators or have better hunting skills.

Environmental factors

It is believed that environmental factors play a less important role in the development of ADHD.

Intake of alcohol during pregnancy can cause fetal alcohol syndrome , which may include symptoms similar to ADHD.

Exposure to tobacco during pregnancy can cause problems in the development of the central nervous system of the fetus and may increase the risk of ADHD.

Many children exposed to tobacco do not develop ADHD or only have intermediate symptoms, which is not enough for a diagnosis.

A combination of genetic predisposition along with some factors such as negative exposures during pregnancy may explain why some children develop ADHD and some do not.

Children exposed to chlorine, even at low levels, or to polychlorinated biphenyls may develop problems similar to ADHD. Exposure to organophosphorus insecticides chlorpyrifos and dialkyl phosphate is associated with 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 several viruses – measles, varicella, rubella, enterovirus 71 – and streptococcal bacterial infection.

At least 30% of children with brain damage develop ADHD and 5% are due to brain damage.

Some children may react negatively to food colors or preservatives. It is possible that some dyes can act as triggers for ADHD in children who are genetically predisposed.

Society

ADHD may represent family problems or with the educational system rather than an individual problem.

Attention Deficit Hyperactivity Disorder (ADHD)

It has been found that younger children in the classroom are more likely to be diagnosed with ADHD, possibly because of the difference in development with their classmates.

The behavior of ADHD occurs most 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 such as the present, in which from the diagnosis of DSM-IV, 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.

Pathophysiology

Current models of ADHD suggest that it is related to functional alterations in some brain neurotransmitter systems, particularly dopamine and norepinephrine.

The pathways of dopamine and noreprinephine originate in the ventral tegmental area and in the locus coeruleus are projected to various brain regions of the brain , controlling several cognitive processes.

The dopamine and noreprinephrine pathways that project to the prefrontal cortex and striatum control executive function (cognitive control of behavior), reward perception, and motivation.

Psychostimulants may have efficacy because they increase the 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.

Cerebral structure

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 a thinning in children with ADHD.

Motivation and executive functions

The symptoms of ADHD are related to difficulties in the 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 the control of the time, organization, procastinación, concentration, information processing, control of emotions or memory of work.

One study found that 80% of people with ADHD had problems in 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 in focusing on long-term rewards. In these children, greater positive rewards improve the execution of tasks. In addition, stimulants can improve persistence.

Diagnosis

The diagnosis of ADHD requires a complete evaluation, because there is no test that detects it.

It is preferable for children to be evaluated by psychiatrists, psychologists or neurologists, rather than by family doctors or pediatricians.

To be diagnosed with ADHD a child should:


  • Show one of the three main behaviors (lack of attention, impulsivity and hyperactivity) before age 12.
  • Behaviors must be more severe than in other children of the same age.
  • The behaviors last more than 6 months.
  • Behaviors occur and affect two areas of life (school, school, social relationships).

In addition, these behaviors should not be related to family problems or stress. Children who have experienced divorce or the deaths of people close to them can suddenly change their behavior.

ADHD-like and similar disorders

2 out of 3 times ADHD disorder occurs in children. The most common are:

  • Tourette’s syndrome.
  • Learning Disorders: occur in 20-30% of children with ADHD.
  • Challenging opposition disorder: occurs in approximately 50% of children with ADHD.
  • Behavior disorder: occurs in approximately 20% of children with ADHD.
  • Primary surveillance disorder: problems are characterized to stay awake and for poor concentration and attention.
  • Sensory overstimulation: it is present in less than 50% of people with ADHD.
  • Mood disorders (depression and bipolar disorder especially).
  • Anxiety disorders .
  • Obsessive compulsive disorder .
  • Substance abuse in adolescents and adults .
  • Restless legs syndrome .
  • Sleep disorders .
  • Enuresis .
  • Delay in language development.

Diagnostic criteria according to the DSM-V

A- Persistent pattern of inattention and / or hyperactivity-impulsivity that interferes with the functioning or development characterized by (1) and / or (2): 3

  1. Inattention

Six (or more) of the following symptoms have been sustained for at least 6 months to a degree that does not match the level of development and directly affects social and academic / work activities:

NOTE: Symptoms are not just a manifestation of oppositional behavior, defiance, hostility or failure to understand tasks or instructions. For older teens and adults (from 17 years of age), a minimum of 5 symptoms are required.

To. Often failing to pay attention to details or carelessly mistakes are made in schoolwork, work or other activities (for example, missed or missing details, work is not done with precision).

  1. He often has difficulty maintaining attention in tasks or recreational activities (for example, he has difficulty maintaining attention in class, conversations or prolonged reading).
  2. He often seems not to listen when spoken to directly (for example, he seems to have the mind in other things, even in the absence of any apparent distraction).
  3. Often do not follow instructions and fails to finish schoolwork, the 1 s chores or work duties (for example, starts tasks but is distracted quickly and easily evades).

and. He often has difficulty organizing tasks and activities (eg difficulty in managing sequential tasks, difficulty putting materials and belongings in order, carelessness and disorganization at work, poor time management, failure to meet deadlines).

  1. He often avoids, dislikes, or is unenthusiastic about initiating tasks that require sustained mental effort (for example, homework or chores in older teens and adults, preparing reports, completing forms, reviewing long articles).
  2. He often loses necessary things for tasks or activities (eg, school supplies, pencils, books, instruments, wallet, keys, work papers, glasses, mobile).
  3. Often easily distracted by external stimuli (for older teens and adults, it may include unrelated thoughts).
  4. He often forgets daily activities (for example, doing homework, doing errands, in older teens and adults, returning calls, paying bills, going to appointments).
  5. Hyperactivity and Impulsivity
  6. A) Six (or more) of the following symptoms have occurred for at least 6 months at an intensity that does not match the level of development and directly affects social and academic / work activities. Note: Symptoms are not just a manifestation of oppositional behavior, challenge, hostility or failure to understand tasks or instructions. For older teens and adults (from 17 years of age), a minimum of 5 symptoms are required.

To. He often fiddles with his hands or feet or writhes in the seat.

  1. He often stands in situations where he is expected to remain seated.
  2. Often runs or climbs in situations where it is not appropriate.
  3. He is often unable to play or quietly engage in recreational activities.

and. He is often “busy,” acting as if he “drives a motor”.

  1. He often talks excessively.
  2. Often responds unexpectedly or before a question is concluded.
  3. It is often difficult for him to wait his turn.
  4. Often interrupts or intrudes with others.
  5. B) Some symptoms of inattention, hyperactivity or impulsivity were present before age 12 years.
  6. C) Several inattentive or hyperactive-impulsive symptoms are present in two or more contexts (for example, at home, at school or work, with friends or family, in other activities).
  7. D) There is clear evidence that symptoms interfere with social, academic or work functioning, or reduce the quality of symptoms.
  8. E) Symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not best explained by another mental disorder.

Depending on the results, the following clinical presentations may be classified:

Combined presentation : if Criterion A1 (inattention) and Criterion A2 (hyperactivity-impulsivity) are met during the last 6 months.

Predominant presentation with lack of attention : if Criterion A1 is met but criterion A2 (hyperactivity-impulsivity) is not met during the last 6 months.

Predominant hyperactive / impulsive presentation : if Criterion A2 (hyperactivity-impulsivity) is met and Criterion A1 (inattention) is not met during the last 6 months.

Treatment for Attention Deficit Disorder and Hyperactivity

Current therapies focus on reducing the symptoms of ADHD and improving functioning in daily life.

The most common treatments are medication, various types of psychotherapy, education and combination of several treatments.

Medication

Stimulants such as metalfenidate 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 brain regions that improve attention, reducing hyperactivity.

In addition, non-stimulant medications such as atomoxetine, guanfacine and clonidine are used.

However, it is necessary to find the medication for each child. A 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 it does control the symptoms while taking it. Drugs can help your child concentrate or learn better.

Psychotherapy

Different types of psychotherapy are used to treat ADHD.

Specifically, behavioral therapy changes behavioral patterns by:

  • Reorganize the school and home environment.
  • Give clear orders.
  • Establish a system of positive and negative rewards consistent 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 lies down. Put the schedule in a visible place.
  • Avoid Distractions : Turn off radio, TV, telephones or computers when your child is doing homework.
  • Limit the options : make 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 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 is good for the child – music, art, sport – to promote their self-esteem and social skills .
  • Parental Help

Children with ADHD need the guidance and understanding of parents and teachers to reach their potential and succeed in school.

Frustration, guilt or hatred in the family may be generated 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 systems and consequences to change the child’s behavior.

Sometimes the whole family may need therapy to find new ways to cope with problem behaviors and encourage behavioral changes.

Finally, support groups can help families connect with other parents with similar problems and concerns.

Alternative therapies

There is little research indicating that alternative therapies can reduce or control the symptoms of ADHD.

Before using any of them, ask a mental health professional if they are safe for your child.

Some alternative therapies are:

  • Diet: Remove foods like sugar or possible allergens such as milk or egg. Other diets recommend removing caffeine, dyes, and additives.
  • Herbal supplements.
  • Vitamins or supplements.
  • Essential fatty acids:
  • Yoga or meditation.

ADHD at school

  • Here are some tips for classes in which there are children with ADHD:
  • Avoid distractions: for example by sitting the child near the teacher rather than near the window.
  • Use a task folder: include progress and notes to share with parents.
  • Dividing tasks: divide tasks into clear and small parts for children.
  • Give positive reinforcement: encourage or give reinforce when the child behaves properly.
  • Supervision: control that the child goes to school with the right books and materials.
  • Encourage self-esteem: prevent children from doing difficult activities in public and encourage when they do things right.
  • Teach study techniques.

Lifestyle

Because ADHD occurs uniquely in each child, it is difficult to give recommendations that work for everyone.

However, some of the following recommendations may help to better control the symptoms:

  • Show affection: children need to hear that they are appreciated. Focusing only on the negative aspects of behavior can damage the relationship and affect self-esteem.
  • Sharing free time: one of the best ways to improve parent-child acceptance is to share free time.
  • Encouraging self-esteem: children with ADHD often perform well in artistic, musical or sports activities. Finding a child’s special talent will improve their self-esteem.
  • Organization: help the child keep a diary of daily tasks. Also, order the workplace so you do not have distractions.
  • Give directions: use simple words, speak slow and give specific orders.
  • Establish schedules: Establish sleep routines and activities, in addition to using calendars to mark important activities.
  • Rest: Fatigue and fatigue can worsen the symptoms of ADHD.
  • Identify situations: avoid difficult situations for the child such as sitting in long presentations, going to supermarkets or boring activities.
  • Be patient: try to stay calm even when the child is out of control.

Complications

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 factor’s

The risk factors can be:

  • Family members with ADHD or other mental disorder.
  • Exposure to environmental toxins.
  • Use of alcohol or drugs from the mother during pregnancy.
  • Exposure of the mother to environmental toxins during pregnancy.
  • Premature birth.

Prevention

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.

Controversies

ADHD and its diagnosis have been controversial since the 1970s.

Positions range from seeing ADHD as a behavior within normal until the hypothesis that it is a genetic condition.

Other areas of controversy include the use of stimulant medications in children, the form of diagnosis and the possible overdiagnosis.

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