ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is a behavioural disorder characterised by the inability to keep focus (inattention), excessive motor activity (hyperactivity), and a tendency to act on a whim or seemingly without thought (impulsivity). ADHD affects individuals in many areas of life such as work, interpersonal relationships, and overall daily functioning. ADHD can lead to poor self-esteem and social functioning in adulthood as many individuals may experience sensitivity towards criticism as well as increased self-criticism.

Around 8.4% of children and 2.5% of adults worldwide have ADHD. ADHD is often first identified in school aged-children experiencing problems with schoolwork.

Symptoms of ADHD

Previously, ADD (attention deficit disorder) and ADHD were considered as separate disorders. However, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not provide criteria for ADD. Today, most manifestations of what was previously diagnosed as ADD are exhibited as inattentive/distractible ADHD type. As a result, manifestations of the disorder are considered as ADHD, however it is important to note that not all individuals with ADHD have hyperactivity symptoms. ADHD can therefore further be distinguished in 3 types:

1. ADHD, impulsive/hyperactive.

Individuals with impulsive/hyperactive ADHD tend to report feeling a need to move, often fidgeting and struggling to remain seated. These individuals appear as they are driven by a motor and exhibit excessive motor activity. Common symptoms of this type of ADHD include:

• Frequently interrupting others

• Difficulty waiting for their turn to speak

• Excessive talking

• Frequently taking risks without thinking before acting

• Difficulty remaining seated for long periods of time

• Fidgeting with hands or objects or squirming in seat

• Difficulty engaging in activities quietly

• Inability to stay on task, shifting from task-to-task without completion.

2. ADHD, inattentive/distractible.

Individuals with inattentive/distractible ADHD often have trouble focusing, staying on task, following detailed instructions, and organising activities. They also struggle with working memory and are easily distracted by external stimuli, resulting in the frequent shifting from projects or tasks before their completion. Symptoms of inattentive/distractible ADHD include:

• Difficulty listening to others
• Difficulty attending to details
• Highly distractible
• Difficulty sustaining attention for long periods of time (i.e., in meetings)
• Forgetful in daily activities
• Frequently making careless mistakes
• Poor organisational skills
• Tendency to lose things often
• Difficulty with tasks that require sustained mental effort

3. ADHD, combined

This is the most common type of ADHD. Individuals with ADHD combined may experience a combination of symptoms from both inattention/distractibility and hyperactive/impulsive types of ADHD.

• Frequently interrupting others

• Difficulty waiting for their turn to speak

• Excessive talking

• Frequently taking risks without thinking before acting

• Difficulty remaining seated for long periods of time

• Fidgeting with hands or objects, or squirming in seat

• Difficulty engaging in activities quietly

2. ADHD, inattentive/distractible.

Individuals with inattentive/distractible ADHD often have trouble focusing, staying on task, and organizing activities. They also stuggle with their working memory and are easily distracted by external stimuli, resulting in the frequent shifting from projects or tasks before their completion. Symptoms of inattentive/distractible ADHD include:

• Difficulty listening to others
• Difficulty attending to details
• High distractibility
• Difficulty sustaining attention for long periods of time (i.e., in meetings)
• Forgetful in daily activities
• Frequently making careless mistakes
• Poor organisational skills
• Difficulty following detailed instructions
• Tendency to lose things often
• Difficulty with tasks that require sustained mental effort

3. ADHD, combined

This is the most common type of ADHD. Individuals with ADHD combined may experience symptoms from both inattention/distractibility and hyperactive/impulsive types of ADHD.

What is ADHD caused by?

The specific cause of ADHD has not been identified, however some research suggests that ADHD has a biological component. Low levels of dopamine, a brain chemical responsible for the feelings of pleasure and reward, are found in individuals with ADHD. Dopamine serves an important role in regulating emotional responses and initiating action to achieve specific outcomes. Further, brain imaging studies show that the cerebral metabolism of individuals with ADHD is lower in areas of the brain controlling attention, judgment, and movement.

Risks associated with ADHD

Individuals with ADHD are at increased risk for behavioural, emotional, and mental disorders.

Behaviour disorders such as oppositional defiant disorder (ODD) and bipolar disorder (BPD) are common comorbidities with ADHD. Individuals with ODD are likely to be defiant and have disruptive behaviour patterns, further exhibiting oppositional behaviours towards authority figures. Individuals with BPD experience extreme mood swings that include emotional highs (mania or hypomania) and lows (depression), often leading to marked impairments in social or occupational functioning. These disorders may increase the risk of interpersonal violence in people with ADHD.

Mood disorders, including anxiety and depression are also common among people with ADHD. Anxiety disorders are found in a large percentage of individuals with ADHD. Those with comorbid anxiety tend to have more severe symptoms and a greater risk for substance use disorders. Depression is also common amongst individuals with ADHD. Depression can occur as a result of difficulty managing symptoms, workload, or interpersonal relationships, resulting in feelings of loneliness, hopelessness, and depression.

ADHD is also strongly linked with impulsive behaviour, leading individuals to be more likely to struggle with self-control, and possibly substance use disorder. Individuals are also more likely to engage in risky behaviour, unsafe sexual practices, and gambling. Increased difficulty with executive functioning and decision-making cause individuals with ADHD to be more prone to engaging in sensation-seeking tendencies, often overlooking the associated risks.

Many individuals with ADHD, notably children, also have a learning disorder. In addition to symptoms of ADHD like difficulty sustaining attention and staying organized, individuals with comorbid learning disabilities may experience more difficulty in school or at work. A learning disability means that an individual has a clear difficulty in one or more areas of learning despite intelligence being unaffected. Types of learning disorders include dyslexia (difficulty with reading), dyscalculia (difficulty with math), and dysgraphia (difficulty with writing).

Sleep disorders are common among people with ADHD. One reason for this is that ADHD can interfere with the body's circadian rhythm - sleep-wake cycle - leading people to feel sleepiness and wakefulness cues at different times than they normally would. Moreover, individuals taking psychostimulant medication may also experience symptoms of sleep disorders, such as difficulty winding down or falling asleep at night.

Diagnosing ADHD

Typically, ADHD symptoms arise in school-aged children and continue throughout adulthood. Sometimes ADHD goes unrecognized in childhood and worsening symptoms lead to a diagnosis later in adulthood. ADHD symptoms manifest differently in males than in females such that men tend to have a predominantly hyperactive/impulsive presentation of ADHD with more externalizing symptoms such as aggression whereas women tend to have a predominantly inattentive presentation with internalizing symptoms such as anxiety. Adult ADHD presents itself differently from childhood ADHD. Childhood ADHD symptoms are sometimes more noticeable, mostly appearing as hyperactivity. Adults, however, have had these symptoms for longer and have oftentimes found techniques to mask their symptoms from the public. In adults, the symptoms of ADHD may be more visible in one's working memory, job performance, or ability to stay on task.

There is no single medical test for ADHD. An ADHD diagnosis can be performed by means of a psychiatric evaluation, using assessment tools such as standardized behaviour rating scales and questionnaires. By looking at the specific ADHD symptoms and assessing the responses to the questionnaires, the evaluator can determine which type of ADHD the individual meets diagnostic criteria for.

Treating ADHD

The most recommended treatment for ADHD includes a combination of medication and therapeutic intervention. The combination is most effective as the medication works to keep brain activity at optimal levels while therapy can help address behavioural issues that an individual with ADHD may be experiencing.

As for pharmacological treatment, psychostimulants are recommended. Other adjunct medications such as alpha agonists and selective norepinephrine reuptake inhibitors can also be prescribed to help treat ADHD symptoms. These medicines target the brain chemicals dopamine and norepinephrine, which affect a person’s concentration and attention.

In terms of therapeutic intervention, cognitive behavioural therapy (CBT) is most recommended. Behavioural therapy, based on cognitive restructuring, serves to help individuals recognize specific cognitions that lead to emotional difficulties that they're experiencing. CBT works to target thought patterns that interfere with an individual's ability to stay on task or get things done. CBT can also further support individuals in managing their ADHD symptoms through teaching them behavioural skills and adaptive thinking strategies which can help with the organizing and executing of daily tasks.

Mindfulness, the practice of bringing one’s attention to the present moment without evaluation or judgement, is gaining popularity as a non-medicinal treatment for the symptoms of ADHD. The practice works to calm the body and mind, targeting the core symptoms of hyperactivity and inattention. This can be achieved through a series of breath-work techniques, most notably the body-scan method, involving the bringing of attention to different parts of the body while maintaining a steady pattern of deep breathing.

When to get help?

ADHD can be very distressing to an individual’s life. An inability to concentrate, organize tasks, or remember information can pose a great burden to daily functioning. If you find yourself having difficulty sustaining attention, managing daily responsibilities, maintaining relationships, or experience other forms of functional impairment, consider seeking help for ADHD treatment.

The Kusnacht Practice is equipped to treat ADHD and ensures health and care excellence. Our team of professionals work to provide an array of specialised mental health therapies and treatments suited to each individual with:

• Psychotherapeutic care

• Medical treatment care

• Biomolecular restoration

• Family systems therapy

The Kusnacht practice also provides treatments for conditions such as anxiety, depression, addiction, and eating disorders. Get in touch if you or someone you know needs treatment for ADHD or any of its comorbid conditions.