BeWell Health Clinic

Attention Deficit Hyperactivity Disorder (ADHD) is a medical disorder that is usually diagnosed during childhood and lasts into adulthood but can be diagnosed in adulthood as well. People with ADHD have variations in brain development and activity, which affects self-control, attention and the ability to remain still. They experience impulsivity, difficulty paying attention and may become overactive.

 

Diagnosis of ADHD

 

A medical exam conducted by a physician is the best firs step in determining whether your child has ADHD. Medical professionals diagnose ADHD using the guidelines from the Fifth Edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5). 

 

If someone has ADHD, they will consistently be hyperactive, inattentive, or both. The behaviour will interfere with their development and function.

 

Inattention

 

Children aged 16 years and below must show at least six symptoms. Adults and adolescents aged 17 years and above should demonstrate at least five signs. In all age groups, the symptoms must be inappropriate for the developmental level and persist for six or more months. A person has ADHD if they often:

·         Fail to pay attention to details and make careless mistakes at work, in school or other activities.

·         Have difficulty holding attention during play or other tasks

·         Do not appear to listen when you speak to them directly

·         Do not follow instructions, and they do not finish chores, schoolwork or workplace tasks

·         Have difficulty organizing activities and tasks

·         Dislike, avoid or are reluctant to engage in tasks that demand mental effort for an extended period such as homework or schoolwork

·         Lose things that they require to execute different tasks such as mobile phones, wallets, keys, pencils, and books.

·         Get distracted easily

·         Show forgetfulness in their daily activities

 

Impulsivity and hyperactivity

 

The diagnostic criteria require at least six symptoms for children of 16 years or less and at least five symptoms for adults and adolescents aged at least 17 years. The symptoms must persist for six or more months and produce a disruptive pattern that is inappropriate for that person’s developmental level. 

 

ADHD symptoms include:

·         Fidgeting with or tapping feet or hands, or squirming on the seat

·         Leaving the seat when the expectation is to remain seated

·         Running around or climbing in inappropriate situations, but adults and adolescent are often limited to restlessness

·         Inability to quietly participate in leisure activities

·         Being constantly on the move

·         Often talking excessively 

·         Often blurting out answers even before hearing the complete question

·         Having difficulties waiting for their turn

·         Often interrupting or intruding on others

 

Also, the person must meet the following conditions

·         Exhibiting several hyperactive-impulsive or inattentive symptoms before the age of 12.

·         Presenting several symptoms in at least two settings (work and home or school and home)

·         Evidence to prove that the symptoms are interfering with or reducing the quality of the school, work or social function.

·         No other mental disorder can explain the symptoms, meaning they do not occur only in the course of a psychotic disorder.

 

The symptoms may change with time and may appear different as age progresses.

 

Treatment of ADHD Using Medication

 

Medication helps manage symptoms and controls behaviour problems arising from ADHD. Some patients may experience total and continuous relief with ongoing treatment from one medication. Others may experience partial relief, or the drugs may seem ineffective. Changing the medication or adjusting the dosage often solves the problem. The doctor may try different types and doses of medicine before they find what works best for each patient.

 

ADHD medications are of two main types:

 

1. Stimulants

 

These are highly effective, fast-acting medications. They are the most common, the best known, and they have been in use for decades. They boost and balance brain chemicals, which in turn improve the symptoms of ADHD. 

 

Examples of stimulants include:

o    Amphetamines such as Dexedrine, Mydayis, Adderall XR and Vyvanse.

o    Methylphenidates such as Ritalin, Concerta, and Focalin

 

Stimulant drugs can either be long-acting or short-acting. A patch of long-acting Daytrana, which can be worn on the hip is available.

 

2. Non-stimulants

 

Non-stimulants are also useful in treating ADHD. They do not act as fast as stimulants, but their effects can last for 24 hours. They are used as alternatives to stimulants if the patient is opposed to stimulants or if an underlying health condition does not allow them to take stimulants. They are also the best option if a patient reacts severely to stimulants. 

 

Examples of non-stimulant drugs include:

 

·         Strattera

·         Intuniv

·         Antidepressants such as Wellbutrin XL and Wellbutrin SR

·         Clonidine (Kapvay, Catapres)

 

Common Side Effects and Complaints About ADHD Medication

 

Medications are often very effective in managing ADHD symptoms. However, some people experience severe side effects. Many reactions are short-term, and a lower dosage of the drugs can control the negative responses. 

 

The side effects of ADHD medications include:

·         Insomnia

·         Delayed growth

·         Loss of appetite

·         Nausea, stomachaches, and headaches

·         Rebound

·         Tics

·         Irritability and moodiness 

·         Sudden death for children with heart rhythm abnormalities or structural heart problems

·         Increased risk of suicidal thoughts in patients using Strattera

 

Challenges of Executive Functioning with ADHD

 

Executive function is a cognitive process that involves organizing thoughts and activities, managing time efficiently, prioritizing tasks, and decision making. Executive function abilities are self-management skills that help set structures and strategies to achieve goals. They help everyone to independently and successfully engage in goal-oriented activities. With ADHD, executive functioning is compromised and a person may experience difficulty in analyzing, planning, organizing, scheduling, and completing tasks.

 

Six cognitive function clusters describe how ADHD affects executive functioning.

 

·         Organizing, prioritizing and activation of tasks: A person with a deficit in this area struggles with starting chores, organizing materials, and differentiating between relevant and irrelevant information. They also struggle with estimating the time necessary to complete a task and planning and anticipating future events. 

 

·         Focus, sustaining and transferring attention: People who quickly get distracted miss out on vital information that they should receive. They get distracted by their thoughts and by things in their surroundings. They have trouble shifting their attention and may get stuck on one idea.

 

·         Regulating alertness, maintaining effort and processing speed: A person who finds it challenging to control alertness may become listless when they must sit quietly and listen. They are unable to remain alert unless you engage them actively.  Also, they may take time to process information while others may be too fast to process instruction with precision.

 

·         Managing frustration and regulating emotions: People with ADHD may lack the ability to tolerate disappointment when they cannot complete a task. They can be highly sensitive to criticism, have intense emotional reactions, and painful feelings can overwhelm them.

 

·         Utilizing the working memory and accessing your recall: The working memory is the brain’s temporary storage system. It holds several thoughts and facts while you perform a task or solve a problem. It helps you retain information for short-term use, focus on the job and recall what next. A person with ADHD may experience difficulties following instructions, memorizing and remembering facts, and retrieving information from their memory when necessary.

 

·         Monitoring and self-regulating actions: People with ADHD cannot control their behavior, which hampers their social relationships. They may react on impulse or focus excessively on other people’s reactions by becoming withdrawn or inhibited.

 

Importance of Therapy in Learning Executive Functioning

 

Mental health professionals are beneficial in assisting children with ADHD and their families. The practitioners use two main types of therapy:

 

· Behavioral therapy

 

The main goal of behavioral therapy is to change behavior from negative to positive. It involves the use of rewards and therapists often combine it with medication. It helps people with ADHD learn how to regulate their behavior by creating a plan of behavior for them to follow. Behavioral therapy enhances new behavior by rewarding positive actions and eliminating undesired behavior.

 

· Cognitive-behavioral therapy (CBT)

 

CBT is a form of talk therapy to get ADHD patients to think about their feelings, thoughts, and behavior. It helps them deal with emotional issues and replace destructive thoughts with positive, more realistic ones to improve their self-confidence. CBT is a type of psychotherapy that helps a person to change their view and perceptions of life, which positively affects their mood and behavior.

 

The Role of Alternative Practices in ADHD

 

Research shows that some alternative approaches may be useful in alleviating symptoms of ADHD. These approaches include:

 

·         Changing the diet: A diet change improves ADHD symptoms. However, consult with your child’s doctor before adjusting the child’s diet. Beneficial dietary changes include:

o    Cutting out refined sugar and processed foods reduces hyperactivity

o    Identifying and eliminating foods that cause food sensitivity and allergies makes your child feel better

o    A bit of complex carbohydrates and a little protein in snacks or each meal keeps the child more alert and decreases hyperactivity.

o    Boosting the levels of iron, zinc, and magnesium helps control ADHD symptoms. More iron improves symptoms nearly as much as stimulant medication does.

o    Adding omega-3 supplements enhances concentration. It also reduces impulsive and hyperactive behavior

 

·         Exercise: Exercising produces hormones that improve mood and boost attention. It also enhances some executive tasks such as prioritizing and planning.

 

·         Going outside: Children use their “voluntary” attention to do chores. Spending time outside allows them to use their “involuntary” attention during the break, and they focus better on tasks that need concentration.

 

·         Mindfulness: This is a routine that promotes concentration on the present. Apart from sitting still, children with ADHD learn different techniques such as breathing deeply to focus their attention on the moment. Focusing on the moment helps the children reduce negative thoughts from past experiences and anxiety about the future.

 

Way Forward

 

ADHD is a medical condition with no cure, but with numerous ways of managing the symptoms. If you, your child or other loved one experiences signs of ADHD, you need to talk to a qualified medical practitioner. The professional will work with you to create a schedule to help you manage ADHD symptoms and live a healthy, productive life.

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