ADHD/ADD

ADHD/ADD
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Overview

Attention deficit–hyperactivity disorder (ADHD) is characterized by the inability to marshal and sustain attention, modulate activity level, and moderate impulsive actions. The result is maladaptive behaviors that are inconsistent with age and developmental level. Attention deficit hyperactivity disorder (ADHD or ADD) is a neurological condition defined by a consistent pattern of inattention and/or hyperactive impulsivity that interferes with daily functioning in at least two settings – for example, at school and at home. It impacts children and adults, boys and girls, and people of all backgrounds.

  • Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.
  • Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
  • Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.

Types of ADHD

To make ADHD diagnoses more consistent, the APA has grouped the condition into three categories, or types. These types are predominantly inattentive, predominantly hyperactivity-impulsive, and a combination of both.

Predominantly inattentive

As the name suggests, people with this type of ADHD have extreme difficulty focusing, finishing tasks, and following instructions. Experts also think that many children with the inattentive type of ADHD may not receive a proper diagnosis because they don’t tend to disrupt the classroom. This type is most common among girls with ADHD.

Predominantly hyperactive-impulsive type

People with this type of ADHD show primarily hyperactive and impulsive behavior. This can include fidgeting, interrupting people while they’re talking, and not being able to wait their turn. Although inattention is less of a concern with this type of ADHD, people with predominantly hyperactive-impulsive ADHD may still find it difficult to focus on tasks.

Combined hyperactive-impulsive and inattentive type

This is the most common type of ADHD. People with this combined type of ADHD display both inattentive and hyperactive symptoms. These include an inability to pay attention, a tendency toward impulsiveness, and above-normal levels of activity and energy.

Symptoms of Inattentive ADHD (aka ADD)

  • Fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
  • Has difficulty sustaining attention in tasks or play activities.
  • Does not seem to listen when spoken to directly.
  • Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
  • Has difficulty organizing tasks and activities.
  • Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).
  • Loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools).
  • Easily distracted by extraneous stimuli.
  • Forgetful in daily activities.

At least six of the following signs of hyperactivity-impulsivity must apply:

Symptoms of Hyperactive ADHD

  • Fidgets with hands or feet or squirms in seat.
  • Leaves seat in classroom or in other situations in which remaining seated is expected.
  • Runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness).
  • Has difficulty playing or engaging in leisure activities quietly.
  • Appears “on the go” or acts as if “driven by a motor.”
  • Talks excessively.

Symptoms of Impulsive ADHD

  • Blurts out the answers before the questions have been completed.
  • Has difficulty awaiting turn.
  • Interrupts or intrudes on others (e.g., butts into conversations or games).
  • Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7.
  • Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).
  • There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

The symptoms do not occur exclusively during the course of a pervasive developmental disorder or other psychotic disorder, and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).

Causes of ADHD

Evidence from neuropsychological, pharmacologic, and brain-imaging studies implicates dopamine and norepinephrine neurotransmitter systems in frontostriatal circuitry in the pathophysiology of the disorder.

Genetic factors appear to play an important role. Attention-deficit/hyperactivity disorder (ADHD) is a highly heritable child-onset condition with a complex genetic architecture. Associations with several catecholamine- and serotonin-related candidate genes of small effect have been confirmed

Extremely low birth weight (less than 1000 g) and environmental conditions, such as head trauma and exposure to lead, are also associated with symptoms of ADHD.

It is also important to determine whether there is a family history of ADHD, depression, bipolar disorder, anxiety disorders, or tic disorders. Genetic disorders that may have symptoms similar to those of ADHD (such as the fragile X syndrome) should be considered.

Research suggests a structural difference in the brain. Findings indicate that people with ADHD have less gray matter volume. Gray matter includes the brain areas that help with:

  • speech
  • self-control
  • decision-making
  • muscle control

Researchers are still studying potential causes of ADHD, such as smoking during pregnancy.

Co-morbidity

Individuals with ADHD also often have a learning disability or one of a number of other mental health problems, like symptoms associated with exposure to trauma, as well as depression, bipolar disorder, obsessive compulsive disorder and other anxiety disorders, Asperger’s syndrome, and other autism-spectrum disorders. Childhood ADHD is also often associated with other behavior disorders, like conduct disorder and oppositional defiant disorder. Therefore, the health care professional will likely screen for signs of depression, manic depression, anxiety, and other mental health symptoms.

 

Treatment for ADHD

There is no cure for ADHD. But the condition can be treated in children and adults with medication and therapy. The NIMH says for the best outcome, a combination of medication and behavioral therapy should be used.

What types of medications are used for ADHD?

Two types of drugs are approved to treat ADHD: stimulants and non-stimulants.

Stimulants. Stimulant drugs are the most commonly used medications to treat ADHD.  Stimulants work by increasing brain chemicals, including dopamine, that are critical for transmitting messages between brain neurons. In kids, 70 to 80 percent show improvement in symptoms within one to two hours of taking the medication. In adults, 70 percent report noticeable improvement from stimulants within hours of using the medication.

Perhaps the oldest prescribed stimulant for the treatment of ADHD is Ritalin. However, given the longer days that older children and teens have compared to young children, stimulants that last longer are usually prescribed for those age groups. Examples of these prescribed drugs include long-acting preparations of methylphenidate, like Daytrana patches, Quillivant-XR liquid, Ritalin-LA, Concerta, and dexmethylphenidate (Focalin-XR), as well as the long-acting amphetamine salt Adderall-XR, Evekeo, and Adzenys XR-ODT.

Non-stimulants. In cases where a stimulant drug is not well tolerated or  preferred, there is atomoexetine (Straterra), a non-stimulant that helps increase a brain chemical called norepinephrine. This chemical can help improve focus, while tamping down impulsiveness and hyperactivity. Clonidine (Kapvay) and Guanfacine (Intuniv) are also non-stimulants and work slightly differently to achieve similar effects.

Dietary Supplements are sometimes used as homeopathic treatments for ADHD. For example, fish oil has been found to effectively treat ADHD in some individuals, particularly for those who have mild symptoms. Positive effects of fish oil in the treatment of ADHD may take as long as three months to become apparent. Some herbs, both alone and in combination with other herbs, have been found to reduce ADHD symptoms in some people with the disorder. Examples of such herbs include ginkgo biloba, brahmi, green oats, and pine bark. Variations in the concentration of herbs from manufacturer to manufacturer can make using these treatments difficult to implement. Vitamins that are thought to improve thinking (B vitamins) may also help improve the thinking and functioning of ADHD sufferers).

Cognitive Behavioral Therapy, Cognitive Therapy and DBT can be option for non-pharmacological treatments.

If you or your loved ones are showing symptoms of ADHD, then must see the psychiatrist.

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Alabama Clinics: 334-712-1170