Today, October 27th is National Attention Deficit Hyperactivity Disorder (ADHD) Day, with the aim of raising awareness about the characteristics and needs of people with this disorder. Dr. Paloma Varela, specialist in Psychiatry and Child Psychiatry, gives us all the details to give visibility to a disorder that is often misidentified and wrongly treated, medically and socially.
Dr. Varela, what is Attention Deficit Hyperactivity Disorder (ADHD) and how does it affect the person who suffers from it, in the short and long term?
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 11% of school-aged children and is characterized by developmentally inappropriate levels of inattention, impulsivity, and hyperactivity. ADHD is a condition that affects people “across the lifespan.” This means that ADHD symptoms are generally experienced from one phase of life to the next, and that they extend into the various spheres of the individual during any particular life phase.
Nevertheless, it is important to note that people with ADHD can be very successful in life. However, without proper identification and treatment, ADHD can have serious consequences, including: school failure, family disruption and stress, relationship problems, substance abuse, depression, delinquency, injury and even job failure. Early identification and treatment are extremely important. Symptoms continue into adulthood in more than three-quarters of cases.
When will someone, child or adult, be considered to have ADHD?
ADHD symptoms usually emerge in early childhood. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), several symptoms are required to be present before the age of 12. When making the diagnosis, children must have six or more symptoms of the disorder present; adolescents 17 years of age or older and adults must have at least five of the symptoms present.
What types of ADHD are there?
The DSM-5 lists three presentations of ADHD: predominantly inattentive, hyperactive-impulsive and combined.
The predominantly inattentive presentation is characterized by:
- Not paying too much attention to detail or making careless mistakes.
- Having difficulty maintaining attention and concentration.
- Having difficulty following instructions.
- Having difficulty getting organized.
- Having difficulty listening, or appearing not to listen.
- Avoiding or seeming to dislike tasks that require sustained mental effort.
- Having a tendency to lose things.
- Being forgetful with daily chores and activities.
- Have a predisposition to be easily distracted.
The predominantly hyperactive-impulsive presentation has the following distinctive features:
- Moving energetically with hands or feet, or squirming in the chair.
- Difficulty sitting still.
- Excessive running or climbing, in the case of children; or extreme restlessness in adults.
- Difficulty participating in quiet activities.
- Acting as if driven by an engine (in the case of adults, they will often feel inside as if they are being driven by an engine).
- Excessive talking.
- Precipitating answers before questions have been completed.
- Having difficulty waiting or taking turns.
- Interrupting or intruding.
The combined presentation is characterized by the individual meeting criteria for both inattention and hyperactive-impulsive ADHD presentations.
What can cause ADHD?
There is no single cause of ADHD; most cases of ADHD arise from a “cluster” of risk factors, genetic and environmental. Most of these risk factors have only a small effect on the causal pathways.
However, there is a strong genetic link, as several genetic studies have shown evidence that ADHD is largely inherited. However, ADHD is a complex disorder, the result of multiple interacting genes. Other environmental factors can increase the likelihood of having ADHD are:
- Toxic exposure during pregnancy and/or early childhood.
- Brain damage.
- Premature birth or low birth weight.
Scientists continue to study the exact relationship of ADHD to environmental factors, but note that there is no single cause that explains all cases of ADHD and that many factors can play a role.
How should ADHD be treated and what type of treatment should it include?
Once a thorough evaluation process is completed by a mental health professional trained in ADHD, intervention will focus on key areas of concern that affect the patient’s functioning. These areas may include school problems, self-esteem or anger management problems, comorbid disorders such as depression or anxiety, learning problems and problems relating to family and peers. ADHD treatment is always multimodal, involving interventions such as:
- Parent training.
- Pharmacological treatment.
- Skills training.
- Behavioral treatment.
- Treatment in the educational setting.
- Psychoeducation on ADHD.
When will pharmacological treatment be considered appropriate?
Medication can be an important part of ADHD treatment. It can help control symptoms, helping to concentrate and pay attention. It can only be prescribed by professionals with experience in the diagnosis and treatment of ADHD and not by other professionals. An accurate diagnosis of ADHD, including an evaluation of other possible associated psychiatric diagnoses, is needed before prescribing these drugs.
Those indicated for ADHD improve the core symptoms of ADHD during the time it is active. Stimulants are the most commonly used medications to control ADHD symptoms and are the first choice of psychopharmacological treatment for patients of all ages with ADHD. Several studies have shown that stimulant and non-stimulant medications reduce ADHD symptoms in children and adults. In contrast, in preschoolers medication is only indicated when symptoms are severe.
The benefits of medication can vary and range from significant improvement in symptoms to mild or modest change in symptoms. Stimulants (lisdexamfetamines and methylphenidate) are more effective than non-stimulants (atomoxetine, guanfacine and clonidine).