What is Attention Deficit Hyperactivity Disorder?

ADHD (Attention Deficit Hyperactivity Disorder) is a common neurodevelopmental disorder.  The average age at diagnosis is age seven with boys and is almost twice as likely to be diagnosed in boys as in girls.[1] Because of its prevalence in children, it was originally widely thought that ADHD did not affect adults.

In August 1954, the International Institute of Child Psychiatry described ADHD as a hyperkinetic impulse disorder that is “characterized by hyperactivity; short attention span and poor powers of concentration; irritability; impulsiveness; variability; and poor schoolwork[2].”

It was not until the late 60s that the American Psychiatric Association (APA) formally recognized ADHD as a mental disorder. There has been a recent upsurge in adults being diagnosed with ADHD. However, this is not because their ADHD started recently, but rather that the symptoms were likely attributed to bad behavior when they were young.

In the United States, an estimated 8.4 percent of children and 2.5 percent of adults have ADHD. [3][4]

There is a wide range of behaviors associated with ADHD, which commonly include:

• Difficulty concentrating and focusing
• Forgetfulness and disorganization
• Being easily distracted
• Having trouble sitting still
• Dominating conversation and talking over people

Inattention, hyperactivity, and impulsivity are key symptoms for an ADHD diagnosis. In children, they must occur in an established pattern, and for adults they must have been present for a period of 12 months or more.

Children are usually diagnosed following observations by teachers or parents. Adults will usually seek a diagnosis following problems at work or in their personal lives.

Subtypes of ADHD

In order to consistently and accurately diagnose ADHD, the American Psychological Association grouped the condition into three types: inattentive, predominantly hyperactivity-impulsive, and a combination of both.[5] ADHD tends to display as predominantly inattentive or hyperactive-impulsive.  However, if someone has six or more symptoms of each type (or five for people over 17 years), they have combined hyperactive-impulsive and inattentive type ADHD.

• Predominantly inattentive (Inattentive ADHD used to be classified as ADD)Symptoms of inattention but not hyperactivity or impulsivity
• Predominantly hyperactive-impulsive type
• Symptoms of hyperactivity and impulsivity but not inattention
• Combined hyperactive-impulsive and inattentive type
• Symptoms of inattention, hyperactivity, and impulsivity

Causes of ADHD

According to the National Institute of Mental Health[6], risk factors which could cause ADHD may include:

• Ancestry/genetics
• Premature delivery/low birth weight
• Drug, alcohol, or tobacco use by mother during pregnancy
• Exposure to toxins such as lead during pregnancy or early childhood
• Brain injury

There is also research into neurological differences that could cause ADHD in adults and children. Imaging studies have shown that ADHD is commonly associated with some structural abnormalities in the brain, including lower grey matter density, white matter abnormalities, cortical differences and reduced total brain volume of some brain structures.[7]  These studies also show evidence of under-or over-activation of some functional brain networks of those with ADHD compared with healthy controls.[8]

Perhaps the most important point to be raised by the neurological research conducted on ADHD patients entails the alterations in communication and activity among various regions and networks within the brain. It has been found that there are disruptions which occur in the relay of messages between neurons by the chemicals dopamine and noradrenaline. Certain dopaminergic neural pathways appear to be delayed in children with ADHD.[9]

Research has shown that people with ADHD may have higher dopaminergic neural pathways than control subjects. The role of these transporters is to remove dopamine from the brain; if levels are higher than usual, dopamine will have a reduced duration of action[10].

Dopamine plays a number of roles within the body and affects a person’s mood, motivation, and attention.  Dopamine is also responsible for regulating the brain’s reward system and increases during pleasurable experiences such as food or sex. This part of your brain is linked closely to memory and motivation, which in turn causes people to seek out pleasurable experiences and potentially get “hooked” on dopamine. This connection has led to extensive research on the role dopamine plays in compulsive habits and the link between ADHD, dopamine levels, and substance use.

It is estimated that over 25% [11]of adolescents and young people who use substances meet the diagnostic criteria for ADHD.  Risk-taking, pleasure-seeking, and impulsive behaviors have been linked to an increased risk of adolescent substance use. This can lead to an increased risk of self-harm, suicidal ideation, suicide and involvement with criminal activity[12]. As ADHD is still widely misunderstood, especially amongst adults, people are often not aware of the additional difficulties that sufferers can have.

Treatment is complicated, as the best-known and most widespread form of treatment for ADHD is the use of stimulants such as Adderall and Ritalin, which themselves can be habit forming. Non-stimulants were approved for the treatment of ADHD in 2003,[13] with behavioral therapy and family-oriented therapies now commonplace and producing effective results.

For more information on treatment, contact Heather R. Hayes & Associates – call 800-335-0316 or email info@heatherhayes.com today.

 

Sources

[1] “Data And Statistics About ADHD | CDC”. Centers For Disease Control And Prevention, 2020, https://www.cdc.gov/ncbddd/adhd/data.html.

[2] LAUFER W. M.D, MAURICE. 1957, https://journals.lww.com/psychosomaticmedicine/Abstract/1957/01000/Hyperkinetic_Impulse_Disorder_in_Children_s.5.aspx. Accessed 16 Nov 2020.

[3] Danielson, Melissa L. et al. “Prevalence Of Parent-Reported ADHD Diagnosis And Associated Treatment Among U.S. Children And Adolescents, 2016”. Journal Of Clinical Child & Adolescent Psychology, vol 47, no. 2, 2018, pp. 199-212. Informa UK Limited, doi:10.1080/15374416.2017.1417860. Accessed 16 Nov 2020.

[4]Ascherson, P. “Review: Prevalence Of Adult ADHD Declines With Age”. Evidence-Based Mental Health, vol 12, no. 4, 2009, pp. 128-128. BMJ, doi:10.1136/ebmh.12.4.128-a. Accessed 16 Nov 2020.

[5] ADHD Vs. ADD: What’s The Difference?”. Healthline, 2020, https://www.healthline.com/health/adhd/difference-between-add-and-adhd.

[6] NIMH » Attention-Deficit/Hyperactivity Disorder”. Nimh.Nih.Gov, 2019, https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml.

[7] Proal, Erika. “Brain Gray Matter Deficits At 33-Year Follow-Up In Adults With Attention-Deficit/Hyperactivity Disorder Established In Childhood”. Archives Of General Psychiatry, vol 68, no. 11, 2011, p. 1122. American Medical Association (AMA), doi:10.1001/archgenpsychiatry.2011.117. Accessed 16 Nov 2020.

[8] PURPER-OUAKIL, DIANE et al. “Neurobiology Of Attention Deficit/Hyperactivity Disorder”. Pediatric Research, vol 69, no. 5 Part 2, 2011, pp. 69R-76R. Springer Science And Business Media LLC, doi:10.1203/pdr.0b013e318212b40f. Accessed 16 Nov 2020.

[9] Tomasi, D., and N. D. Volkow. “Functional Connectivity Of Substantia Nigra And Ventral Tegmental Area: Maturation During Adolescence And Effects Of ADHD”. Cerebral Cortex, vol 24, no. 4, 2012, pp. 935-944. Oxford University Press (OUP), doi:10.1093/cercor/bhs382. Accessed 16 Nov 2020.

[10] Johnson, Shannon. “What Is The Link Between ADHD And Dopamine?”. Medicalnewstoday.Com, 2019, https://www.medicalnewstoday.com/articles/325499.

[11] Mariani, John J. et al. “Treatment Strategies For Co-Occurring ADHD And Substance Use Disorders”. American Journal On Addictions, vol 16, no. s1, 2007, pp. 45-56. Wiley, doi:10.1080/10550490601082783. Accessed 16 Nov 2020.

[12] Huemer, Julia et al. “The Influence Of Reported ADHD And Substance Abuse On Suicidal Ideation In A Non-Clinical Sample Of Young Men”. Neuropsychiatrie, vol 30, no. 3, 2016, pp. 131-137. Springer Science And Business Media LLC, doi:10.1007/s40211-016-0198-6. Accessed 16 Nov 2020.

[13] Treatment Of ADHD | CDC”. Centers For Disease Control And Prevention, 2020, https://www.cdc.gov/ncbddd/adhd/treatment.html.