ADHD: Diagnosis, Types and Treatment

ADHD: Diagnosis, Types and Treatment

ADHD: Diagnosis, Types and Treatment

ADHD stands for Attention Deficit/Hyperactivity Disorder. It is a very common neurodevelopmental disorder. It is usually first diagnosed in childhood and continues into adulthood. The common characteristics of children with ADHD are trouble paying attention, controlling impulsive behaviours, and being overly active. This pattern of inattention and hyperactivity-impulsivity is persistent and interferes with everyday functioning and development.

Diagnosis of ADHD

There is no singular test that can determine if a child has ADHD or not. The symptoms of ADHD are very similar to other problems like sleep disorders, anxiety, depression, and certain types of learning disabilities. Usually, healthcare providers follow the guidelines present in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) to help diagnose ADHD. The following are the diagnostic criteria listed in the manual:

1. Inattention:
  • Failure to give attention to details. Making careless mistakes in schoolwork, work, and other activities.
  • Trouble holding attention to one task.
  • Not listening when being spoken to directly.
  • Trouble following through on instructions.
  • Failure to finish schoolwork, chores, or responsibilities at the workplace.
  • Frequent distraction and being side-tracked by other activities.
  • Forgetfulness in daily activities.
  • Avoidance of tasks that require mental effort for a long duration.
  • Frequent loss of materials necessary for tasks (ex. Stationery for schoolgoing children)
2. Hyperactivity and Impulsivity:
  • Fidgeting, tapping hands and feet, squirming while sitting
  • Leaving their seat when remaining seated is expected and appropriate
  • Running about and climbing things (in adults, it is limited to feelings of restlessness)
  • Inability to participate in leisure activities quietly
  • Excessive talking
  • Trouble waiting for their turn/in queues
  • Frequent interrupting of others

A common symptom of ADHD is Executive Dysfunction. It refers to difficulties in cognitive functions such as maintaining attention, memorising and processing new information, ignoring distractions, and regulating emotions. A mental healthcare professional diagnoses ADHD if six or more of the following symptoms are present in children under the age of 16, or 5 or more are present in adolescents and adults for at least 6 months. They must be present in two or more settings, such as at home, school, or the workplace. There should be evidence that the symptoms interfere with or negatively impact the quality of routine functioning.

Types of ADHD

Based on the types of symptoms exhibited by a person, ADHD has three presentations:

  1. Combined Presentation: This is the most common type of ADHD. It is diagnosed when a person shows impulsive and hyperactive behaviours as well as inattention and distractibility.
  2. Predominantly Inattentive Type: As the name suggests, in this type of ADHD, the person has difficulty focusing and concentrating on one task. They have trouble following instructions. Experts think that several children with inattentive presentation of ADHD remain undiagnosed because they do not disrupt the classroom. Research has also suggested that it is more prevalent in girls than in boys.
  3. Predominantly Hyperactive-Impulsive Type: People with this presentation exhibit impulsivity symptoms. Boys tend to present hyperactivity and other externalising symptoms more than girls.

Causes of ADHD

The exact cause of ADHD has not been determined, but several factors affect the development of the condition. Research has indicated that it might have both neurological and genetic origins.

  1. Neurological Factors: A few of the neurological factors that have been associated with ADHD are the reduction in dopamine (a chemical in the brain that helps transport signals from one nerve to another); having less grey matter volume (the part of the brain that helps with speech, self-control, decision-making, and muscle control).
  2. Genetic and Birth-Related Factors: ADHD has been found to run in families. Links have also been made to the use of alcohol or smoking during pregnancy to ADHD in the child. Other risk factors are – premature delivery, low birth weight, and exposure to environmental risks such as lead during pregnancy or infancy.
Treatment Options

In most cases of ADHD, a combination of medication and therapy is the best treatment option.

  • Medication – The two main types of medicines prescribed after an ADHD diagnosis are stimulants and non-stimulants. Central Nervous System Stimulants are the most commonly prescribed ADHD medications. They work by increasing the supply of chemicals in the brain such as dopamine and norepinephrine. Examples are Methylphenidate, Dextroamphetamine, and a mixture of amphetamine salts. Non-stimulants are prescribed when stimulants are not adequately effective or have unwanted side effects. A common non-stimulant is Atomoxetine.
  • Psychotherapy and behaviour therapy are also effective. The objective of behaviour therapy is to help children eliminate problem behaviours of inattention and impulsivity that might strain their school performance and affect their relationship with their parents, teachers, and peers. Parent training may also be included, which involves training them in behaviour management, skills and strategies to help their child. Training and behaviour management skills may also be provided to teachers since ADHD is usually diagnosed in school-going teachers.

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