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Attention deficit hyperactivity disorder (ADHD) is a developmental disorder that greatly affects a person’s behavior. ADHD manifests as restlessness, inattention, and a tendency to make impulsive decisions without considering the consequences. These symptoms appear in childhood and often accompany a person throughout their entire life. We are going to answer important questions about ADHD – how this developmental disorder manifests, why it is incorrect to call it a disease, and how to adapt to life despite the unique features of one’s brain.
What is ADHD?
Attention deficit hyperactivity disorder (ADHD) is one of the neurodevelopmental disorders. This means that the syndrome arises due to a malfunction in the brain’s functioning, predominantly in areas responsible for attention. It can manifest as early as childhood, but diagnosing ADHD in preschool children is difficult as many children at this age are impulsive and inattentive, making it hard to distinguish between normal behavior and abnormal behavior.
The child psychiatrist explains why ADHD is not a disease: “ADHD should be called a developmental disorder. It is not a disease or a condition that can be cured. It is a feature that makes it difficult for both children and adults to plan tasks, execute them, and be patient during the process.”
How does ADHD manifest itself? How is this condition different from normal laziness?
ADHD is characterized by three main symptoms: inattention, impulsivity, and hyperactivity. It seems that these signs can be found in any child or adult. In fact, everyone has been distracted during lessons, impatient while waiting in line, or made a hasty decision without thinking it through.
The difference between these situations and ADHD is that with developmental disorders, such symptoms are present from childhood, constantly affect several areas of life, and even with great effort, a person cannot control or only does so with difficulty. As a result, this has a negative impact on their life, their emotional state, their ability to learn (they may have to switch schools, and they might even be expelled from university), and then on their ability to perform their work duties. “Simple childhood hyperactivity or laziness doesn’t affect quality of life,” Osin explains. “If a child is scolded for getting twos and threes, they can pull it together and improve their grades. But with ADHD, they always get bad grades, even though their intellectual abilities allow them to at least achieve a passing grade.”
“The lives of people with Attention Deficit Hyperactivity Disorder are noticeably more difficult than the lives of their peers,” continues Elisha Osin. “To conform to society’s rules, one must possess developed self-control. This requires the ability to stop oneself, restrain oneself, and endure well. With ADHD, this is difficult to do. For these same reasons, patients may often have issues with mood, self-esteem, and success.”
Under threat are the physical health of people with disabilities: the risk of any injury is higher, especially if they do not take medication.
At the same time, people with ADHD have situations where their attention is not scattered, but on the contrary, just like people without ADHD, it is completely absorbed by some favorite or simply fascinating activity. This state is called hyperfocus. During it, it is easy to start playing an online game and not notice how the process takes away several hours of life.
What causes attention deficit hyperactivity disorder (ADHD)?
Cerebral Palsy is classified as a neurodevelopmental disorder, and therefore, the main cause is a malfunction in brain function. However, what exactly works differently and how strong the impact of this malfunction is, no one knows for sure. International recommendations and patient guidelines state that numerous internal and external factors influence the development of cerebral palsy.
They include:
- Structural changes in the brain. There is data that in the brain of a person with ADHD, certain areas differ in volume from standard sizes. However, not all patients with this diagnosis have this characteristic, and brain imaging studies are not necessary to make a diagnosis.
- Congenital chemical imbalance in the brain. It is possible that ADHD develops due to an disturbed balance of neurotransmitters, substances that nerve cells use to transmit signals. However, this could also be a result of other changes that are actually the cause of ADHD.
- Genetic characteristics. Predisposition to ADHDis inherited, and the likelihood of its transmission is very high – about 80%. However, this percentage only works when inheriting a specific combination of genes, and in the case of ADHD, there are many such combinations. Therefore, the genetic factor is considered important, but it does not determine for sure whether a child will have ADHD or not.
- Premature birth, low birth weight, and head injury at a young age. These factors are more common in children with cerebral palsy, but it is unclear how they are causally related and whether these phenomena lead to cerebral palsy.
- Smoking during pregnancy. Children born to smoking mothers are more likely to have ADHD, but it is unclear whether smoking directly increases the risk of developing attention deficit hyperactivity disorder.
- Nutrition. The most controversial risk factor for the development of ADHD. On one hand, there are studies that suggest that, for example, food with an excess of simple sugars or foods containing food additives affect the manifestations of ADHD in children. On the other hand, these studies are not reliable enough to draw conclusions based on them for all patients with ADHD. Therefore, international and national recommendations do not advise restricting any products for children with ADHD. However, if parents are convinced that there is some connection, they need to keep a food diary to start with. In any case, if certain groups of products are to be excluded from the diet, it should be done under the control of a dietician, so that the person does not end up with a deficiency of any substances.
How do doctors understand that a person has ADHD?
Often, even outside of the United States, criteria formulated in the American Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) are used for this purpose. A doctor (usually a psychiatrist) can diagnose ADHD if the following conditions are met.
A person must have at least six signs of inattentiveness if they are 16 years old or younger, and at least five signs if they are 17 years old or older.
Signs of inattention
These are the characteristics:
- Being careless and making errors due to a lack of attention to detail
- Difficulty in maintaining focus during activities such as games, household chores, and schoolwork
- Ignoring people even when directly addressed
- Inability to complete tasks
- Problems with planning and organizing tasks
- Avoidance of tasks that require sustained mental effort
- Losing frequently needed items, such as textbooks or sports equipment
- Being easily distracted
- Forgetting about routine tasks
- To diagnose hyperactivity and impulsivity, a person must have at least six signs before age 16, or at least five signs at age 17 or older.
Signs of hyperactivity and impulsivity
These are the characteristics:
- Excessive restlessness, such as frequent fidgeting or tapping of feet
- Inability to sit for long periods, even when necessary
- Impatience, running in circles or climbing inappropriately for the situation (in children)
- Difficulty playing quietly, often in children
- Constant movement, making it difficult to catch up with the person
- Talkativeness
- Difficulty waiting for turn
- Interrupting or interfering in others’ conversations or games
However, to diagnose hyperactivity and impulsivity, these signs must:
- Occur frequently
- Be present in multiple areas of life, such as at home, school, and activities
- Persist for at least six months
- Be present before the age of 12
- Negatively affect the person’s performance in studying, communication, or work
- Be excessive for the person’s age.
The 10th revision of the International Classification of Diseases (ICD-10) also includes criteria for ADHD, but they are now considered outdated. For example, the ICD-10 criteria state that to diagnose ADHD, a person must exhibit signs of both attention deficit and hyperactivity. However, it is now understood that only one of these characteristics may be predominant in some cases.
Good news: ШСВ-11 is being implemented worldwide. It divides ADHD into subtypes based on the predominance of one of the symptoms. The classification also takes into account symptoms in adults, and overall it is closer to the modern understanding of ADHD and DSM-5 criteria. The transition to it is planned to be finalized by 2025.
How to suspect oneself of having ADHD?
There are at least two questionnaires available to help determine if there are signs of ADHD in both adults and children. It is important to note that a consultation with a psychiatrist is necessary to make a diagnosis, but completing these questionnaires may raise suspicion of a developmental disorder. It is worth mentioning that these questionnaires were developed and tested a long time ago, and some diagnostic criteria have changed since then.
The Adult ADHD Self-Report Scale is one questionnaire that adults can use. Its brief version is available in Russian, and the full version can be found in English.
For children, the Scale of Developmental Age of Speech and Language can be used.
They say that children with ADHD can “outgrow” it. Is it true?
This is not an easy question to answer unequivocally. “It was previously believed that about half of children completely outgrow ADHD,” says psychiatrist, psychotherapist, and author of a psychiatry blog, Kirill Sychyov, in response to our question. “Now that number has decreased, but it is unclear whether children actually outgrow the developmental disorder, simply adapt, and how often they seek help from specialists in the future.”
According to modern data, 40-60% of adults who were diagnosed with ADHD in childhood continue to face problems caused by this syndrome. The more severe the expression of ADHD in childhood, the higher the risk that symptoms will not go away in adulthood, although they may become less noticeable.
How many people have ADHD?
The frequency of ADHD varies in different countries primarily due to the use of different diagnostic criteria. On average, ADHD is found in 5.29% of people worldwide. There is limited data on ADHD prevalence in developing countries. Psychiatrist Elisey Osin notes that ADHD is underdiagnosed in developing countries. He believes that people with ADHD are often misdiagnosed or not diagnosed at all, and various guidelines emphasize that ADHD can be confused with other disorders. Moreover, people with ADHD may also have other disorders that are prioritized during diagnosis, resulting in missed ADHD diagnosis.
Some people believe that ADHD is overdiagnosed and that such symptoms did not exist in the past. However, scientific literature shows that people with similar symptoms were identified in the past, and diagnoses simply had different names at the time.
How to treat ADHD if it is a congenital developmental disorder?
Antibiotics cannot cure ADHD like bacterial pneumonia, but individuals can reduce or eliminate their symptoms and improve their quality of life by adopting different approaches such as environmental adaptation, skill training, medication, psychotherapy, and other methods.
To minimize distractions and improve planning, individuals can make changes to their surrounding environment by following a precise schedule, using checklists, taking frequent breaks, wearing earplugs, and setting small, achievable goals. This is referred to as environmental adaptation.
In the world, drugs from the group of psychostimulants are often used. For example, methylphenidate, dextroamphetamine, lisdexamfetamine, dexmethylphenidate.
There are also other, less effective drugs that are not stimulants. Atomoxetine is mainly referred to in this case – according to the instructions, it can be prescribed from the age of six. It increases the amount of norepinephrine in the brain, a chemical substance that is lacking in the brain of a patient with ADHD. This restores a person’s ability to concentrate and control their emotions.
In certain countries, there are no official recommendations for the treatment of ADHD, but doctors often prescribe nootropics and antipsychotic drugs to such patients. Nootropics are drugs that are supposed to improve brain function in theory. They include drugs such as piracetam or glycine. Unfortunately, there are not enough good studies that show the effectiveness of these drugs at least for ADHD. Nootropics are also not included in European and American guidelines for the treatment of attention deficit hyperactivity disorder. However, despite the lack of scientific evidence, they are prescribed around the world. For example, nootropics are still included in some current Russian clinical recommendations for other disorders and conditions.
Antipsychotics, including neuroleptics, are drugs used to reduce excitement, hallucinations, delusions, and aggression in patients. However, they should not be used to reduce impulsiveness or hyperactivity in patients with ADHD, and less harmful methods should be attempted first. These drugs may only be necessary in cases of aggressive or self-aggressive behavior, which may occur in conjunction with other mental disorders.
What psychotherapy methods help people with ADHD?
There are several types of psychotherapy and psychological support that work for ADHD. For example, children with ADHD are advised to attend group training sessions where they can interact with other children with the same diagnosis and learn to adapt to society together. Parents are also advised to attend programs where they will be informed about the features of ADHD and how to support their children and provide them with comfort properly.
Usually, cognitive-behavioral therapy (CBT) and group training are recommended for ADHD. According to psychologist Evgenia Dashkova, who conducts CBT skills training for people with ADHD, psychotherapy in this case is aimed at developing two skills – organization and emotional management.
Group sessions have advantages: in particular, they are cheaper, and during them, a person is surrounded by people with the same diagnosis and feels support.
If a person is not ready to go for psychotherapy, they can try to do tasks on their own. Evgenia Dashkova recommends taking a look at a workbook with exercises for people with ADHD. It is intended for children, but you can learn to concentrate with its help at any age.
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