A sneak peek into a classroom will show us children with variety of behaviours. We may find some children who are constantly not paying attention in the class, look fidgety and disturb kids around them. These children could be suffering from an undiagnosed medical problem which has treatment.
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition which impacts an individual’s academic, work, personal and social life. Individuals with ADHD, due to the nature of their symptoms, are frequently labelled as lazy, trouble makers, losers. They are predisposed to academic failures, depression, addictions, anxiety and other mental health conditions.
Symptoms of this condition can be grouped into the domains of inattention and hyperactivity/impulsivity.
A child with inattention may not be able to focus in the classroom, may look lost while talking to, not able to follow instructions, do not complete tasks like homework on time. They may avoid any boring or monotonous tasks or tasks that require concentration. Child with hyperactivity will appear to always be on the go as though driven by a motor, not able to sit in a place when it is expected like say a classroom or ceremonies, appear fidgety or restless, move around all the time. Child with impulsivity may not be able to wait for his/her turn, blurt out answers even before the question is complete, butt into others conversations, speak out of their turn, be reckless. These problems can exist in various combinations and severity in individuals with ADHD.
In general, the symptoms have an onset before the age of 12. However, mild cases may go unnoticed especially in a very structured environment.
In many of the cases, symptoms continue on to adulthood though the symptoms may vary. Inattention and impulsivity usually persist and hyperactivity takes the form of unexplained subjective restlessness. They may avoid mundane tasks, procrastinate commitments, have difficulty in meeting deadlines. They also tend to have difficulties in regulating their emotions and may have repetitive anger outbursts, emotional breakdowns.
In adolescence and young adulthood, it is more likely for these individuals to have early onset of substance use like alcohol, smoking, illicit drugs, behavioural addictions like gaming. They may also have a tendency to get involved in high-risk behaviours like rash driving, unsafe sexual practices, multiple sexual partners.
Genes may play a role in the pathogenesis of ADHD. Hypo-functioning of certain brain regions, predominantly the prefrontal cortex is a consisting finding in various studies. These regions are involved in sustained attention, ability to inhibit impulses, ability to delay gratification, planning and organization, thus explaining the symptoms of ADHD. There are alterations in the levels and functioning of certain neurotransmitters, predominantly dopamine and norepinephrine in the brain of these individuals.
Environmental risk factors include perinatal associations like maternal smoking and alcohol consumption during pregnancy, certain prescription drugs, stress and medical conditions in the mother, low birth weight, prematurity, obstetric complications. Childhood history of depriving environments, certain medical illnesses have been found associated with ADHD symptoms, though some are reversible.
Yes. Pharmacological treatment includes medicines that restore the neurotransmitter imbalances in the brain of these individuals. With the help of these medicines, they’ll be able to focus better, be less hyperactive and impulsive. Non pharmacological treatments will include parent management training, individual therapy, environmental modifications to suit the needs of these individuals. It is important to involve teachers in school, parents in the management plan. It is also important to look for comorbidities and treat them since comorbidities are more of a rule than exception in individuals with ADHD.