Attention Deficit/ Hyperactivity Disorder (ADHD)

Attention-Deficit/ Hyperactivity Disorder (ADHD)

As far as health is concerned, it is essential to note that human physical health is directly or indirectly affected by their mental health. Any strict diet, medication, or treatment cannot treat an individual unless he has a healthy emotional balance. Today, many children are being diagnosed with various kinds of mental illness, and ADHD is one such common disorder among children and youngsters. These kinds of mental disorders leave a negative impact on a child’s mental health as it is challenging to face the consequences of mental issues and try to overcome them. Attention deficit hyperactivity disorder (ADHD) is a type of mental disorder among children that also persists in adulthood. It affects the child’s mental health, adversely making him hyperactive and unable to pay proper attention (Agnew-Blais et al., 2018). ADHD was first reported in 1902 by a British pediatrician called George Still. Later in 1968, the symptoms such as lack of attention and impulsive behavior among its patients were observed. Almost 4- 9 % of Children get affected by ADHD, whereas it persists among 50-80% of adults since their childhood (Corral, Hernández).  

Symptoms of ADHD include:

Inattention

Hyperactivity

Impulsiveness

Depression 

Anxiety

Consequences of ADHD include: 

Poor-academic performance

Behavioral change 

Sleeplessness

Hyperactivity

Inability to manage relationships

Unemployment

Involvement in criminal activities

It is difficult to diagnose ADHD as its symptoms coincide with various other mental disorders such as anxiety disorders, learning disorders, dissociation disorders, and behavioral disorders. A patient has to go through many phases during its diagnosis.  ADHD has biological characteristics related to brain development. Several neurological studies have been conducted to categorize ADHD as a neurodevelopmental disorder.

Neurobiological basis of ADHD

There are many factors responsible for ADHD, and one of them is a neurobiological basis. Xavier Castellanos discovered that the volume of ADHD patients is 3% less than the healthy brains of normal people. According to neurobiological aspects, decreased levels of prefrontal cortex volume have been found in patients with ADHD, which controls attention, response, and social behavior. The change in corpus callosum has also been observed, which transfers information of the inter-hemisphere. The differences in the cerebellum, basal ganglia, and grey and white matter in frontal lobes have been found. The neuronal circuits are associated with behavioral and mental activities such as memory, thoughts, and feelings. In the central nervous system, during synaptogenesis, neuron cell changes, and neuron circuits are formed due to the synaptic contact between neurons. It happens before birth and during the initial months after birth. ADHD is the result of abnormalities in the development of circuits and synaptic circuits in the prefrontal cortex due to the mutation of genes (Morga, 2019). These neurological abnormalities are known as NSS (Neurological soft signs).

As these abnormalities are associated with the delicate areas of the brain, they are called ‘soft.’ NSS is generally divided into three categories, such as ‘integrative sensory,’ which is associated with sensory perception like audio, visual, sense, touch, and taste. Motor coordination is associated with way of walking and balancing. Complex motor sequencing is associated with motor activities such as object-controlling with hands, sliding, and swimming. A study conducted on 20 healthy and 23 children with ADHD confirms that NSS is associated with cognitive impairments of ADHD disorder (Pitzianti, 2017). According to many studies, if the condition of NSS in children continues into their adolescence stage, then it can lead to severe psychiatric disorders. It can cause abnormal development of the brain leading to many neurodevelopment disorders, including ADHD (Agati et al., 2018). Dopamine is a neurotransmitter synthesized in our body and is responsible for sending messages among nerve cells. It enables us to feel pleasure and respond to rewards. Patients with ADHD are found with a deficiency in Dopamine, which makes them hyperactive. This deficiency caused due to genetic influence.

According to a study, sluggish cognitive tempo (SCT) symptoms have been observed in children who have ADHD. The symptoms of SCT include daydreaming, physical weakness, sleepiness, social and emotional impairments, and low self-esteem. This study was conducted on a sample of 178 children of eight to twelve years randomly. The results were shocking as the symptoms of SCT increased, and volumes of the prefrontal cortex also increased, whereas ADHD patients have decreased the volume of the prefrontal cortex. The motor dysfunction of children with psychological disorders cannot be categorized only as ADHD. It may result in many unknown pathophysiological aspects of attention. This study highlighted the distinction between neurological developments and abnormalities in children with ADHD and STC. STC is recognized as a subtype of neurodevelopment disorder (Sussman and Posner,2018)

Children with severe symptoms of ADHD are more likely to face severe psychiatric diseases. The symptoms of ADHD often coincide with other mental disorders; therefore, it is difficult to diagnose and treat patients with ADHD with multiple mental disorders. Similar genetics, as well as the neurobiological basis, may lead to ADHD. ADHD patients are more likely to develop more than one mental disorder. Therefore, a separate profile is required for each patient’s condition (Ayaz, 2019). 

Preschool children have been observed to develop ADHD (attention-deficit/hyperactivity disorder) due to environmental and genetic aspects, which played an essential role in forming symptoms of ADHD. The symptoms of ADHD were examined among the siblings between 1.5 to 5 years. The correlation between genetic aspects was found to be 58-89 %. The influence of the similar environments shared by the siblings was minimum. However, the influence of environmental factors increased in various age groups of children was also examined. There is no proof of the differences between these changed sequences among males and females. The symptoms of ADHD are strongly hereditary as the children of 1.5 with ADHD are found to be associated with genetic effects (Eilerstan et al.,2019)

As it has been proved, that ADHD is a heritable disorder, but there are many other factors responsible for ADHD. It has been examined that around 10-40% of ADHD symptoms are developed due to the influence of environmental factors. The prenatal environment plays a vital role as discussed earlier; it is a period of synaptogenesis in which neurocircuits are formed. The common reasons behind the risk of the influenced prenatal environment are the smoking habit of pregnant women or their prematurity during pregnancy may lead to the reduced cognitive development of the fetus. However, even after conducting many studies on it, there is still no substantial evidence to identify the confirmed association between these prenatal risk factors and ADHD. Further studies are required to find the exact prenatal risk factors responsible for ADHD (Sciberras et al., 2017).

Many young children in their adolescence get addicted to smoking and become nicotine dependent. The time of adolescence is essential for cognitive development, and the habit of smoking inhibits the healthy development of the brain. It might result in the thinner front part of the cortex, and abnormalities in grey matters of the front part of the smokers were found to be 2.6 % thinner than the people who do not smoke. However, the thinning process speeds up in regular smokers compared to people who do not smoke regularly. There was not much difference found between the thickness of non-smokers and the people who smoke rarely. It proves that smoking causes a thinner front cortex. However, smokers are more likely to have symptoms of ADHD, but still, it alone may not be responsible for the development of ADHD (Akkermans et al.,2017)

A study was conducted to understand the nature of ADHD and the outlook of ADHD patients in various groups. Participants were selected depending on the factors like people who were diagnosed with ADHD and had children affected with ADHD as well. They were above the age of 18, and most of them were able to speak English fluently. The sample included six parents of children aged three to twenty years affected by ADHD. A grandparent of a 17-year-old child. There were around four parents with more than one child affected with ADHD. A few parents between the age of 40-45 years were diagnosed with ADHD, and a couple of parents of the same age group was diagnosed with depression. Almost all these participants shared their experiences; many of them could speak English fluently. All of them were well educated with degrees, one participant was a student, and a few were professionals and homemakers (Ghosh et al., 2016)

According to a study, fourteen young people responded to the interviews conducted to know their perceptions, sufferings, and experiences of coping with the symptoms of ADHD. Most of them responded that they felt unworthy and isolated as they could not connect with the environment and the people around them. They felt that they have a strange kind of personality that would not fit in their surrounding environment. Their responses were different, but the ways to deal with the symptoms of ADHD included three steps, such as identifying the symptoms, trying to change the environment, and trying to control themselves. There were many similarities in their outlook and the way of coping with ADHD disorder (Ringer and Cerniglia et al., 2019)  

Identification of Symptoms: Many primary-school children of 3 to 7 seven years are often diagnosed with ADHD. They find difficulty in concentrating, sitting, and behaving properly. Teachers complain about inactive behavior, and other children refuse to play with such hyperactive kids. The diagnosis of ADHD is not easy as it involves many phases and assessments such as parents’ opinions, observation, and the rating of the child’s behavior. Interviews are conducted with the children, teachers, parents, or guardians. Various kinds of activities are given to the children to observe their behavior and performance directly. Rating scales include the checklist of Child behavior (CBCL), Strengths, and difficulties a questionnaire (SDQ), A home version rating scale of ADHD, and conners rating scale. Interviews help to identify the problematic behavior of the child and their social association. Interviews with teachers and parents help to identify the issues related to the behavior and the aspects that can reduce behavioral issues. Direct observations are conducted to know about the child’s behavior at home and school, and their relationship with friends and teachers. It enables differentiation between the behavior of hyperactive and non-hyperactive children. The activities which are used to observe the performance of the child include small assessments such as matching similar figures. A matching picture is shown above the options to elicit quick responses from the children. Many children respond promptly. 

Treatment of ADHD: The common modes of treatment are medications and psychological programs for improving the cognitive behavior of the patients. Parental support is essential to treat ADHD as they first accept the situation and get prepared to face the challenges. In Pharmacotherapy stimulants, medications such as Methylphenidate-based (Ritalin, Concerta, Focalin, Metadata, Daytrana) and amphetamine-based (Adderall, Dexedrine, Vyvanse ) are widely used to treat ADHD. There are no specific guidelines to identify whether pharmacotherapy is required or not or when it is required. The treatment of pharmacotherapy works by increasing the levels of catecholamines (including dopamine and norephedrine). It aims at treating the deficiency of dopamine. It shows excellent effects in adult people with ADHD. 

Other options of treatment include the counseling of parents, Parenting tools, school-based environmental changes, and CBT. Parental counseling is carried out using videos of parent-child interactions. It improves the understanding and attention abilities of a child. They try to respond to the environment and learn to manage their behavior in a public setting. Behavior therapy trains the people associated with children, such as teachers, guardians, and parents. It follows the rewarding process to promote the behavior management of the child. Parents and teachers offer rewards so that children improve their behavior to achieve their rewards. Another way of treating ADHD is Environmental manipulations, which aim at modifying the child’s environment, making them feel comfortable. In schools, the seating arrangement of the child is changed; the duration of the periods is reduced so that a child can learn to pay attention for a short time as it will be difficult for the children with ADHD to focus on something for a long time. Teachers praise children along with gifts and incentives for their performance, which motivates them positively to improve. Instructions are provided directly in the note-taking form. Children are not burdened with a lot of homework or activities, and they are assisted in the classroom in completing their tasks effectively. They are taught to follow the instructions of the classroom and post classroom rules. At home, they are allowed to play with minimum friends and toys. Cognitive behavior therapy enables a child to manage his behavior. A CBT therapist treats the children individually or in groups depending on the case and requirements of the child. He focuses on improving the behavior of children in various situations by identifying their issues and way of responding to situations. 

Conclusion:

Attention deficit hyperactivity disorder (ADHD) is a type of mental disorder among children that also persists in adulthood. It affects the child’s mental health, adversely making him hyperactive and unable to pay proper attention. It is difficult to diagnose ADHD as its symptoms coincide with various other mental disorders such as anxiety disorders, learning disorders, dissociation disorders, and behavioral disorders. A patient has to go through many phases during its diagnosis. Children with severe symptoms of ADHD are more likely to face severe psychiatric diseases. The symptoms of ADHD often coincide with other mental disorders; therefore, it is difficult to diagnose and treat patients with ADHD with multiple mental disorders. According to a study, fourteen young people responded to the interviews conducted to know the perception of their perceptions, sufferings, and experiences of coping with the symptoms of ADHD. Most of them responded that they felt unworthy and isolated as they could not connect with the environment and the people around them. They felt that they have a strange kind of personality that would not fit in their surrounding environment. Their responses were different, but the ways to deal with the symptoms of ADHD included three steps, such as identifying the symptoms, trying to change the environment, and trying to control themselves. Interviews are conducted with the children, teachers, parents, or guardians to diagnose ADHD.

Various kinds of activities are given to the children to observe their behavior and performance directly. Rating scales include the checklist of Child behavior (CBCL), Strengths, and difficulties a questionnaire (SDQ), A home version rating scale of ADHD, and conners rating scale. The common modes of treatment are medications and psychological programs for improving the cognitive behavior of the patients. Parental support is essential to treat ADHD as they first accept the situation and get prepared to face the challenges. The treatment of pharmacotherapy aims at the deficiency of dopamine. It shows excellent effects in adult people with ADHD. Other options of treatment include the counseling of parents, Parenting tools, school-based environmental changes, and CBT.