It is unclear whether Attention-Deficit/Hyperactivity Disorder (ADHD) is more common today than before, but it is evident that the prevalence rates of
diagnosed and treated cases have escalated over time.
The rise can partially be attributed to greater awareness of the symptoms and an expansion of what is considered to be ADHD. So said Dr Uschenka Padayachey of Milnerton Akeso Psychiatric Clinic.
"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," Padayachey continued.
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 explained.
- · Inattention refers to an individual who wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; 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 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 percent of individuals younger than 18 years and in 2.5 percent 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
She pointed out that the aetiology of ADHD is considered to be 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 and 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
Padayachey stressed 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 majority of individuals ADHD medication reduce the symptoms of hyperactivity and impulsivity and improve their ability to focus, work, and learn,”
Padayachey pointed 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 explained.