ADHD – Attention Deficit Hyperactivity Disorder

It’s a complex brain disorder that impacts approximately 11 percent of children and almost 5 percent of adults in the India. Neuroscience, brain imaging, and clinical research challenge the old understanding of ADHD as a behaviour disorder. We now understand that ADHD is a developmental impairment of the brain’s self-management system — its executive functions.

What are the causes of ADHD?

The causes of ADHD remain somewhat unclear. Research suggests that genetics and heredity play a large part in determining who gets attention deficit hyperactivity disorder. However, scientists are still
investigating whether certain genes, especially ones linked to the neurotransmitter dopamine, play a defined role in developing ADHD. Additional research suggests that exposure to toxins and chemicals
may increase a child’s risk of having ADHD.

ADHD is not caused by bad parenting, too much sugar, or too many video games. ADHD is a brain- based, biological disorder. Brain imaging studies and other research show many physiological differences in the brains of child with ADHD.

What is are the 3 sub-types of ADHD

The Diagnostic and Statistical Manual of Mental Disorders (DSM) previously identified three types of ADHD:

  • Primarily hyperactive-impulsive type
  • Primarily inattentive type (formerly called ADD)
  • Primarily combined type

People with hyperactive-impulsive subtype of ADHD act ―as if driven by a motor‖ with little impulse control — moving, squirming, and talking at even the most inappropriate times. They are impulsive,
impatient, and interrupt others. People with the inattentive subtype of ADHD are easily distracted and forgetful. They may be
daydreamers who lose track of homework, cell phones, and conversations with regularity. Individuals with combined-type ADHD display a mixture of all the symptoms outlined above.
These subtypes are now considered ―presentations‖. Leading Pediatric Neurologist in Mumbai, Dr. Krupa Torne says that, “children often move from one subtype to another”. For example, a child
may present as primarily hyperactive-impulsive in preschool and lose much of the hyper arousal in adolescence to fit the primarily inattentive presentation. In college and adulthood, the same individual
may transition to combined presentation.

The subtypes were primarily based on overt behavioral symptoms, and ignored less visible symptoms like emotional dysregulation, cognitive patterns, and sleep difficulties. Behavioral symptoms imperfectly capture the defining features of ADHD. Non-behavioral characteristics are increasingly recognized in research and diagnosis.

What are the Symptoms of ADHD?

A child may be diagnosed with ADHD only if he or she exhibits at least six of nine symptoms from one of the lists below, and if the symptoms have been noticeable for at least six months in two or more settings — for example, at home and at school. What’s more is that the symptoms must interfere with the child’s functioning or development, and at least some of the symptoms must have been apparent before age 126. Older teens and adults may need to consistently demonstrate just five of these symptoms in multiple settings.

What Are the 9 Symptoms of ADHD – Primarily Inattentive Type?

  • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).
  • Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
  • Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
  • Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).
  • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).
  • Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
  • Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
  • Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

What Are the 9 Symptoms of ADHD – Primarily Hyperactive-Impulsive Type?

  • Often fidgets with or taps hands or feet or squirms in seat.
  • Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).
  • Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.)
  • Often unable to play or engage in leisure activities quietly.
  • Is often ―on the go, acting as if ―driven by a motor (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).
  • Often talks excessively.
  • Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).
  • Often has difficulty waiting his or her turn (e.g., while waiting in line).
  • Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).

What is the treatment of ADHD?

When their child is diagnosed with ADHD, parents often have concerns about deciding the best way to help their child. It is important for parents to remember that ADHD can be successfully managed.
There are many treatment options, so parents should work closely with everyone involved in the child’s life—healthcare providers, therapists, teachers, coaches, and other family members. Taking advantage of all the resources available will help parents guide their child towards success.

Two treatment plans are of importance:

  • Behaviour Therapy, including training for parents
  • Medications

For children 6 years of age and older, Dr. Krupa Torne recommends both Behavior therapy and medication as good options, preferably both together. For young children (under 6 years of age) with ADHD, behavior therapy is recommended as the first line of treatment, before medication is tried. Good treatment plans will include close monitoring of whether and how much the treatment helps the child’s behavior, and making changes as needed along the way. Treatment plans usually include the school environment. To learn more about the International recommendations for treatment of children with ADHD, subscribe to our Facebook Page and call ICPN Mumbai for the newsletter.