While children with ADHD can be a handful, treatment options including medication, psychotherapy, psycho-education, and behaviour training can go a long way to alleviating the negative effects of the disorder.

ADHD is multi-factorial with numerous genetic, biological, and environmental factors contributing to the development of the disorder.

The rise in diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) can partially be attributed to greater awareness of the symptoms and an expansion of what ADHD is considered to be. Some experts feel that ADHD is over-diagnosed, while others feel it is under-diagnosed or under treated.

“This said, the correct treatment combination of medication and therapy, along with education, and family support, can go a long way in mitigating the negative effects of ADHD, improving the quality of life of persons suffering from the disorder, says Dr Uschenka Padayachey of Milnerton Akeso Psychiatric Clinic.

DEFINITION

(ADHD) is defined by the American Psychiatric Association as a neurodevelopmental disorder characterised by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, she explains.

Inattention refers to an individual who wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganised; and these problems are not due to defiance or lack of comprehension.

Hyperactivity, on the other hand, means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.

Impulsivity refers to an individual who makes hasty actions that occur in the moment without first thinking them through and that may have high potential for harm, or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.

DEMOGRAPHICS

According to Dr Padayachey, ADHD is a common mental health disorder which begins in childhood and can persist into adulthood. According to international research, ADHD occurs in 5% of individuals younger than 18 years and in 2.5% of adults.

“A widely acknowledged clinical observation is that it is more common in males than in females, with a ratio of approximately 2:1 in children and 1.6:1 in adults. In males their impulsivity and hyperactivity may appear as disruptive behaviour, while inattentiveness is a hallmark of ADHD in girls, however, because they aren’t often disruptive in the classroom, they may be harder to diagnose.

MULTI-FACTORIAL

Dr Padayachey points out that the aetiology of ADHD is multi-factorial with numerous genetic, biological, and environmental factors contributing to the development of the disorder. Risk factors identified include:

  • Genes
  • Prematurity
  • Low birth weight
  • Cigarette smoking
  • Brain injuries
  • Exposure to environmental toxins during pregnancy
  • Exposure to environmental toxins, such as high levels of lead, at a young age

ADHD TYPES, SYMPTOMS

The three subtypes of ADHD that have been identified based on the presence or absence of the key behaviours include:

  • Predominantly inattentive presentation
  • Predominantly hyperactive/impulsive presentation
  • Combined presentation

“Clinical presentation varies according to developmental stage. Symptoms can appear as early as between the ages of 3 and 6 and can persist through adulthood. Children with ADHD can be erroneously identified as having emotional or disciplinary problems or missed entirely in well-behaved but inattentive children, leading to a delay in diagnosis. Adults with undiagnosed ADHD may have a history of poor academic performance, problems at work, or difficult or failed relationships.

“ADHD symptoms are found to be dynamic in accordance with ageing. In young children with ADHD, hyperactivity-impulsivity is the most predominant symptom. As a child reaches primary school, the symptom of inattention may become more evident and impact on academic performance. In adolescence, hyperactivity seems to lessen and manifests as feelings of restlessness or fidgeting, but inattention and impulsivity may remain. Inattention, restlessness, and impulsivity persist into adulthood.

DIAGNOSIS

Dr Padayachey stress that a diagnosis of ADHD requires a comprehensive evaluation by a clinician with expertise in ADHD. “The diagnosis of ADHD requires the symptoms of inattention and/or hyperactivity-impulsivity to be persistent and cause functional impairment. It is essential to ensure that any ADHD symptoms are not due to another medical or psychiatric condition. Most children with ADHD receive a diagnosis during the early school years. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present prior to age 12.”

TREATMENT

According to the American Academy of Paediatrics, pharmacotherapy is effective for most children. Behavioural interventions are also valuable as a primary treatment or as an adjunct treatment for many children.

For a majority of individuals ADHD medication reduce the symptoms of hyperactivity and impulsivity and improve their ability to focus, work, and learn,” Dr Padayachey points out.

“The most common type of medication used for treating ADHD is called a ‘stimulant’. Stimulant medications work by increasing the brain chemicals dopamine and norepinephrine, which are implicated in thinking and attention pathways. Under medical supervision, stimulant medications are considered safe but there are associated risks and side effects such as raised blood pressure and heart rate and increased anxiety.

“Non-stimulant medications are also used in the treatment of ADHD. These agents take longer to start working compared to stimulants but do improve attention and impulsivity in a person with ADHD. Non-stimulants are considered when a person has side effects from stimulants, when a stimulant is not effective or in combination with a stimulant to increase its effectiveness,” she explains.

PSYCHOTHERAPY

According to Dr Padayachey, psychotherapy is an essential treatment used to treat ADHD by assisting patients and their families to better cope with everyday problems. “Behavioural therapy is a type of psychotherapy that aims to help a person change his or her behaviour. It might involve practical solutions, such as help organising tasks or completing schoolwork, or working through emotionally difficult events.

“Cognitive behavioural therapy can also teach an individual mindfulness techniques, or meditation. A person learns how to be aware and accepting of one’s own thoughts and feelings to improve focus and concentration.

“Family and couples therapy can help family members and spouses find better ways to handle disruptive behaviours, to encourage behaviour changes, and improve interactions with the patient.”

EDUCATION, TRAINING

“The National Institute of Mental Health (NIMH) advocates that children and adults with ADHD need a supportive environment in order to reach their full potential and to succeed. For school-age children negative emotions may have built up within a family before a child is diagnosed. Parents and children will require assistance to overcome these negative feelings. Through education parents learn about ADHD and how it affects a family and are taught new skills, attitudes, and ways of relating to each other,” Dr Padayachey points out.

Parenting skills training teaches parents the skills they need to encourage and reward positive behaviours in their children. They learn how to use a system of rewards and consequences to change a child’s behaviour. Parents are taught to give immediate and positive feedback for behaviours they want to encourage, and ignore or redirect behaviours that they want to discourage.

“Support groups can help parents and families connect with others who have similar problems and concerns. Groups meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.

“While there is no cure, an ADHD diagnosis is not the proverbial end of the road. Treatment options including medication, psychotherapy, psycho-education, and behaviour training can go a long way in alleviating the negative effects of the disorder, making life much easier for everybody concerned,” Dr Padayachey concludes.