The origin of ADHD is multifactorial. Genetic aspects are largely involved, in fact it is one of the psychiatric disorders with the highest heritability. However, there are also non-genetic biological factors and environmental factors that play an important role in its development and especially in the way it manifests itself. These include pre-, peri- and postnatal factors, such as low birth weight, maternal smoking and alcohol consumption, and obstetric complications. In addition, a troubled emotional climate in the home is associated with a poor prognosis of ADHD in adulthood.
How to recognize a person with ADHD?
The core symptoms of ADHD patients are inattention, impulsivity and hyperactivity. However, there are three subtypes of clinical presentations: the most frequent is the combined presentation, in which all three symptoms coexist. In addition, there is the predominant presentation with inattention, and the predominant hypoeractive/impulsive presentation.
Patients with a combined presentation of symptoms are individuals who in childhood have generally had academic difficulties in relation to attention problems or a performance not very commensurate with the overexertion made. In addition, excessive restlessness and impulsivity produce behavioral problems in the classroom and generate difficulties in relationships, often leading to social rejection.
These behavioral alterations at school and in the family environment mean that patients do not go unnoticed and, therefore, they are referred to consultations earlier than other patients with ADHD but with different symptoms.
On the other hand, patients with signs related to attention deficit are usually referred later, since in most cases school problems do not begin until the academic demands are not high. For this reason, many patients have compensated their attention deficit with a good intellectual capacity and with the support of their parents in their studies. This form of presentation is more frequent in girls, despite the fact that ADHD is more prevalent in boys.
In addition to the difficulty in maintaining attention, these people usually have complexity in the executive functions involved in planning and organization processes, which increases when they reach adolescence and adulthood, with the consequent limitations in the academic, work and family environment.
The behavior of patients with ADHD
ADHD has an impact on patients that varies throughout life.
In school-age children, behavioral problems and difficulties in academic performance appear, together with problems in social relationships as a consequence of excessive impulsivity and motor restlessness.
When these problems are maintained and reach adolescence they produce academic failure, so that self-esteem is increasingly affected. This often causes a worsening of the prognosis of patients, since there is an abuse of alcohol and other substances.
People with ADHD in adulthood continue to have difficulties in emotional regulation, are more unstable, with more problems in relationships. Due to difficulties in planning and organization, they find it difficult to finish and complete tasks, and have difficulties at work. At this stage of life, comorbidity with other psychiatric disorders coexists in more than half of the cases.
ADHD in adults
ADHD is a more prevalent disorder in childhood and adolescence, with about 6% incidence in children. However, more than half of the cases persist into adulthood. For this reason, it is important to keep in mind that symptoms of impulsivity and hyperactivity diminish over time, but inattention remains.
Another characteristic of ADHD, both in childhood and adulthood, is comorbidity with other psychiatric disorders in up to 2 out of 3 patients. Among the most frequent are depressive disorders, anxiety, substance use disorder and eating disorders.
Treatment for ADHD
The process has to be individualized and multimodal. It should always include a psychoeducational approach to the parents, the child and his or her environment and a close relationship between professionals: physicians, psychologists, teachers and family members.
Studies place combined treatment as the best option, that is, pharmacological treatment in conjunction with cognitive-behavioral psychotherapy.
The psychotherapeutic option may be recommended as an initial treatment alone in mild cases, or when parents reject the use of medication. Parents are generally concerned about the possible “addiction” to these drugs, and it is important to explain to them that in medicated patients the risk of having a substance abuse disorder is reduced by half.
The pharmacological treatment of choice is stimulants (Methylphenidate, Lysdexamfetamine), although non-stimulant drugs such as Atomoxetine and Guanfacine are also marketed. They are well-tolerated and safe drugs with significant reduction of ADHD symptoms.