Attention Deficit Hyperactivity Disorder (ADHD)
Attention Deficit Hyperactivity Disorder, also known as, "ADHD" or "ADD", is a neurodevelopmental disorder that affects executive functioning and is characterized by symptoms of inattention, impulsivity, and hyperactivity. ADHD and ADD are used interchangeably, but the proper term is ADHD as ADD is outdated. In many cases of ADHD, the hyperactivity component may be missing; however, it is usually masked by a mood disorder, such as, anxiety or depression.
ADHD occurs in both men and women of all ages, and typically develops in childhood and can persist into adulthood. ADHD causes challenges with time perception, impulse control, organization, regulating attention, and the ability to stay on task, which leads to frustration, impatience, anger, and excitability. These symptoms can interfere with daily life, school, work, and social relationships.
Since the 1970s, ADHD and its diagnosis and treatment have been considered controversial; however, it is now a validated clinical diagnosis in both children and adults. Children present with disruptive behavior and difficulty paying attention, which results in poor school performance. In adults, hyperactivity usually presents as restlessness, and these individuals often develop coping mechanisms to compensate for their impairments.
It is important to recognize that although individuals with ADHD have difficulty focusing on tasks they aren't particularly interested in, they are able to attend and maintain an unusually prolonged and intense level of attention for tasks they find enjoyable, rewarding, and stimulating; this is known as "hyperfocus." This is very positive and beneficial because it provides these individuals with an amazing ability to get in the zone and immerse in a task for hours on end.
Causes
The exact cause of ADHD is unknown, but it is believed to be a combination of biological, environmental, and genetic factors. ADHD tends to run in families, but each person's symptoms and experience with ADHD is completely unique.
Research suggests that ADHD may be related to brain anatomy and function, prematurity, brain injury, and maternal stress and toxin exposure during pregnancy. Childhood trauma can produce ADHD-like symptoms, but it is not a proven cause of ADHD.
Pathophysiology
On a deeper level, individuals with ADHD may have a genetic defect that causes an imbalance of neurotransmitters, such as dopamine and norepinephrine. Dopamine is the neurotransmitter responsible for regulation of attention, tasks, and pleasure.
Individuals with ADHD have low dopamine, which causes a discoordination between neural circuits that control attention, task completion, and decision making, which leads to a constant state of craving and seeking more.
Signs + Symptoms
Symptoms of ADHD are expressed differently throughout the lifespan and less intensely as individuals age. Girls and women with ADHD tend to present with less hyperactivity and impulsivity and more symptoms of inattention and distractibility than boys and men.
As kids age, hyperactivity usually lessens and masks into inner restlessness, difficulty relaxing or sitting still, and talkativeness or constant mental activity in teens and adults with ADHD.
Impulsivity in adulthood may appear as thoughtless behavior regardless of the consequences, impatience, irresponsible spending, and engaging in risky behaviors, while inattention may appear as becoming easily bored, difficulty with organization, staying on task, decision making, and handling stress.
Some common symptoms:
- Difficulty paying attention and staying focused on mundane, non interesting tasks.
- Easily distracted or annoyed by what's going on.
- Impulsivity or interrupting others.
- Lack of motivation.
- Hyperfocus on enjoyable and stimulating tasks.
- Restlessness, hyperactivity, or anxiety.
- Challenges with time perception.
- Procrastination and usually running late.
- Fidgeting, squirming, or unable to sit still.
- Difficulty with quiet activities and waiting for one's turn.
- Temper outbursts and mood fluctuations.
- Excessive talking.
- Disrupted working memory and short-term thinking.
- Forgetfulness.
- Sugar and carbohydrates cravings.
Remember that, not everyone with ADHD experiences the same symptoms, and they can vary with age and severity.
It is of the upmost importance, if you are experiencing any of the symptoms above and are not working with a therapist, to seek a professional mental health clinician.
Diagnosis
ADHD is diagnosed by a mental health professional, such as a psychiatrist or psychologist. The diagnostic process typically involves screening tools and a comprehensive evaluation that includes a review of the individual's medical history, symptoms, and behavior.
The diagnostic criteria for ADHD includes the presence of symptoms of inattention, hyperactivity, and impulsivity to a degree much greater than others of the same age for at least 6 months. These symptoms must directly interfere with quality and functioning of daily life and be present in multiple settings, such as, school, work, home, or social environments.
A mental health professional can help determine whether an individual's symptoms meet the diagnostic criteria for ADHD or another mental health condition, and develop a treatment plan that is personalized to their needs and goals.
Treatment
Treatment for clinically diagnosed ADHD involves a combination of medication, psychotherapy, and lifestyle changes. Medications used to treat ADHD include stimulants, like Adderall or Ritalin, which increase levels of dopamine and norepinephrine, and can help improve attention and reduce hyperactivity and impulsivity; however, they do come with cardiovascular side effects and risk for abuse/misuse.
As mentioned above, ADHD, its diagnosis, and treatment have been considered controversial; however, kids who take stimulant medications are able to rewire attentional circuitry to develop stillness, focus, decision making skills, and impulse control through neuroplasticity. These kids are able to learn certain actions and behaviors that they can carry with themselves throughout their lifetime and likely come off their medications as adults.
Psychotherapy can help individuals with ADHD develop coping strategies, improve social skills, and address emotional issues. Cognitive behavioral therapy (CBT) can also be effective in helping individuals with ADHD improve their organization and time management skills. Lifestyle changes such as regular exercise, a whole foods nutrient dense diet, and good sleep hygiene also help manage symptoms of ADHD.
The goal of treatment is to gain awareness of the attention deficit, impulsivity, and hyperactivity and learn new behaviors that help control impulses and increase focus, so that the symptoms no longer interfere with everyday life and social relationships.
The success of treatment depends on the individual's or parent's willingness to engage in psychotherapy, use medications, and change lifestyle behaviors. Treatment requires long-term management, participation, and empowerment for these individuals with ADHD.
Supportive Lifestyle Habits for ADHD
Carrying a Fidget Toy engages physical energy and enhances the ability to focus. In school, tying a rubber band to kids' desks provides them with tactile stimulation and the ability to expel physical energy while staying focused and engaged in learning.
Elimination of added sugars and sugary drinks helps reduce symptoms of ADHD, especially in children. High consumption of sugar leads to increased hyperactivity and dopamine release, which causes more cravings for it.
Regular exercise helps release pent-up energy, promote dopamine release, and improve executive function in the brain. In children with ADHD, physical activity has been shown to improve attention and decrease impulsiveness and aggression. Aerobic exercise and team sports are very beneficial for these individuals as well.
Behavioral training and visual focusing are beneficial for kids in building attention and engaging focus circuits in the brain. To perform these exercises, have kids concentrate on a different object; for example, looking at a hand, then another point in the room, and then even further point in the room for 20-60 seconds each time. These exercises work best when done after movement and physical activity.
Meditation trains focus and concentration. Individuals with ADHD can learn to become more aware of their thoughts and emotions, and how to observe them in a nonjudgmental, objective manner. Research shows that just 17 minutes of interoception and focusing on breathing is able to rewire attentional circuitry and synchronize neural networks that work together to control focus.
Proper sleep is essential for cognitive function and mood, especially in individuals with ADHD. Sleep deprivation increases the inability to focus and decreases productivity. Individuals with ADHD need more sleep and rest to think and function well.
Final Thoughts
ADHD can be a very frustrating and complex condition to treat and live with because it's difficult to draw a line at where normal levels of inattention, hyperactivity, and impulsivity end and significant levels requiring interventions begin. Individuals with ADHD experience difficulty focusing, prioritizing, sitting still, controlling impulses, regulating attention, and organizing their time. On the bright side, individuals with ADHD are able to attend and have the ability to hyperfocus on things that genuinely interest them and stay "locked in" for extended periods of time.
If you or someone you know is struggling with ADHD, or any other mental health condition, please seek professional help from a licensed mental health professional. Always remember, that you do not have to wait until symptoms are overwhelming or out of control to seek help. Do not suffer or just try to keep pushing through. Reach out to family and friends and talk about your concerns with your primary care provider, who can refer you to a mental health professional.
If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lifeline.org to reach the 988 Suicide & Crisis Lifeline.
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