Encapsulation of ADHD: Causes, Effects, & Treatments

The content below is solely information base and should not be considered as a substitute to professional medical advice.

Mridul Kapoor

25^th March 2018

Abnormal Psychology Paper

Encapsulation of ADHD: Causes, Effects, & Treatments

Attention Deficit/Hyperactivity Disorder

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by hyperactivity, inattention, and impulsivity which interfere with the daily functioning of a human being. According to the National Institute for Health, attention-deficit/hyperactivity disorder, also commonly known as ADHD, is one of the most common mental disorders in children and adolescents. It also affects an estimated 4.4 percent of the adult population in the United States in a given year (NIH Fact Sheets – Attention Deficit Hyperactivity Disorder (ADHD), 2013). A student from the George Washington University who is prescribed to the regular use of ADHD medication describes the after effects as a zombie-like feeling. Still, medicine-based treatment is increasing annually at an average rate of 7% (Attention-Deficit / Hyperactivity Disorder (ADHD), 2018). However, it is more often diagnosed amongst males than females with a ratio of 1.6:1 in adults and 2:1 in children. Amongst most cultures, ADHD is present in 2.5% of the adult population and 5% of the child population (American Psychiatric Association, 2013). This paper analyzes the causes and the effects of ADHD and suggests different treatments available.

History of ADHD

In the past, ADHD was considered a transient childhood disorder; it was believed that a child would outgrow it upon entering teenage years. It was foreseen as something that is caused by environmental factors such as inconstant parenting rather than genetic and biological factors such as brain development (NIH Fact Sheets – Attention Deficit Hyperactivity Disorder (ADHD), 2013). According to the National Survey of Children’s Health, ADHD in children has increased 17% within 13 years from 4.4 million in 2003 to 6.1 million in 2016 (Attention-Deficit / Hyperactivity Disorder (ADHD), 2018). Since ADHD was not recognized as a serious disorder until the late 1960s and early 1970s, educating the general population today about the disorder would help to fight this increasing problem, creating a friendlier world for people suffering from ADHD disorder.

ADHD Signs and Symptoms

According to the DSM-5, an essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with daily function or regular development (American Psychiatric Association, 2013).

The three categories of signs and symptoms for ADHD mentioned above are usually early onsets, before the age of seven. However, a person does not need to have all three symptoms to be diagnosed with ADHD. One person with ADHD could be very hyperactive whereas another could be extremely quiet with his mind wandering in a completely different place. Although all the symptoms are inter-connected, they could vary in intensity. For example, the same child could be mildly impulsive but overly inattentive or vice versa. More specifically, a few common symptoms amongst many include poor planning, frequent mood swings, poor time management skills, disorganization and problem prioritizing (Attention Deficit Hyperactivity Disorder, 2016).

Hyperactivity & Impulsivity

These two categories are coincidental; the children who are hyperactive generally also show traits of being impulsive. Hyperactivity refers to excessive motor activity when it is not appropriate; on the other hand, impulsivity refers to hasty actions that occur in the moment without forethought. For people diagnosed with ADHD, these symptoms are more complicated and disturbing. As defined in the DSM-5, the following are a few symptoms associated with hyperactivity and impulsivity; for at least 6 months, six or more of the following symptoms should be present in children but only five or more in adults age 17 and above (American Psychiatric Association, 2013):

• Often fidgets with or taps hands or feet or squirms in seat
• Often leaves the seat in situations when remaining seated is expected.
• Often runs about or climbs in situations where it is inappropriate
• Often talks excessively
• Often unable to play or engage in leisure activities quietly
• Often has difficulty waiting for his or her turn
• Often blurts out an answer to a question before it has been completed
• Is often “on the go” acting as if “driven by a motor”

Imagine someone who is always impatient and fidgets constantly sitting on a seat or someone who always talks nonstop and out of order; once these symptoms become more regular, they start causing hindrance to one’s daily life.

Inattention  

According to the Oxford dictionary, inattention simply mean lack of attention or distraction; something that everyone has encountered at some point in their lives. (Inattention, 2018). In the case of ADHD, according to the fifth edition of the DSM, inattention manifests behaviorally in ADHD as wandering off tasks, lacking persistence and being disorganized and not due to defiance or lack of comprehension (American Psychiatric Association, 2013). These symptoms affect a person’s daily life and can result in a lack of self-control. Following are the specific symptoms that have been categorized in the DSM-5 which correlate to inattention:

• Often does not seem to listen when spoken to directly
• Often fails to give attention to details or makes careless mistakes during work
• Often does not follow through on instruction and fails to finish tasks
• Often has difficulty in organizing tasks and activities
• Often has difficulty in sustaining attention in tasks or play activities
• Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort.
• Often loses things necessary for tasks and activities
• Is often easily distracted by extraneous stimuli

Out of the symptoms mentioned above, six or more should be present in children and five or more in adults age 17 and older, for a minimum duration of 6 months (American Psychiatric Association, 2013).

Causes of ADHD

ADHD is not a result of low intelligence, lack of motivation or laziness, it is a much more complex medical disorder. Although scientists have not pinned any one reason for ADHD, the causes can broadly be divided into four prognostic factors.

Temperamental

A temperamental person is someone likely to have unreasonable and unjustifiable mood shifts. As per the DSM-5, temperamental moods that contribute to the development of ADHD are “effortful control or constraint, negative emotionality and/or elevated novelty seeking”. These traits can predispose some children to ADHD; however, these traits are not specific to the disorder (American Psychiatric Association, 2013).

Environmental

According to the DSM-5, exposure to environmental toxins such as “smoking during pregnancy, low birth rate, as well as reaction to aspects of diet to some extent his correlated to ADHD”. Other factors that also contribute to ADHD diagnosis include the history of child abuse, neglect, bad childhood and multiple foster placements (American Psychiatric Association, 2013).

Genetic

ADHD has significant heritability; it is elevated in the first-degree biological relatives of individuals with this disorder. Therefore, if a parent or a sibling of a person has been diagnosed with ADHD, there is a comparatively higher probability for that person to also be diagnosed with the disorder. A few possible influences, mentioned in the DSM-5, to be considered on ADHD symptoms are “metabolic abnormalities, sleep disorders, nutritional deficiencies and epilepsy” (American Psychiatric Association, 2013).

Physiological

The DSM-5 does not associate ADHD with any specific physical features. However, because of ADHD, certain physical abnormalities can become more prominent; “subtle motor delays, twitches, and other neurological soft signs” could also occur (American Psychiatric Association, 2013).

ADHD Diagnosis

Even though ADHD has very generic symptoms, it is not easy to diagnose. Many children with true ADHD are often misdiagnosed with oppositional defiant, conduct disorder or intermittent explosive disorder (Kearney & Trull, 2011). Medical professionals need to perform certain tests and evaluations, such as a full physical test for diagnosis. They collect data from various sources about the patient, such as medical history, and school performance history to reach a conclusion. It is important to again note that amongst all the symptoms listed in the DSM-5, at least six or more in children and five or more in adults should be present for a minimum of six months. The FDA has also approved the use of Neuropsychiatric EEG-Based Assessment Aid (NEBA) System, a noninvasive scan that measures theta and beta brain waves; these waves have proven to be higher in children with ADHD. (Attention Deficit Hyperactivity Disorder: Diagnosing ADHD, 2017). Medical conditions that can mimic the symptoms of ADHD make it hard to distinguish it from other disorders like bipolar disorder, autism, low blood sugar levels, and sleep disorder. For example, a person with bipolar disorder might have hyperactivity, impulsivity, and inattention too, but these features are episodic; on the other hand, bipolar disorder is rare in preadolescent whereas ADHD is not.

Treatments for ADHD

ADHD is not a curable disorder, however, there are different treatments that help in controlling the symptoms. If left untreated, it can be life-impairing; a gateway to other problems in life such as marital and relationship issues as well as difficulty in school and work. Amongst the various conditions that have been controversial in modern America, ADHD has recently soared. There are a number of treatment methods available that help a patient cope with this disorder.

Biological Therapy Treatment

Biological treatment also referred to as pharmacological treatment, is the use of stimulating medication to support and emphasize necessary brain functions. Since ADHD is not curable, medication aides in controlling the symptoms making them less intrusive in daily life. There are five types of medication used to control ADHD, namely Methylphenidate, Dexamphetamine, Lis-dexamphetamine, Atomoxetine, Guanfacine; Adderall, Focalin, Concerta, and Methylin are some of many brand names of ADHD drugs available in the market. These medicines are prescription stimulants that work to increase the activity in the brain of two major brain chemicals – dopamine and norepinephrine. Dopamine is associated with the feeling of pleasure, which in the case of ADHD are amplified using the stimulants, and Norepinephrine affects blood pressure, blood sugar, heart rate and blood vessels (National Institute of Drug Abuse, 2018). It is because of this amplification of the feeling of pleasure that stimulants have a high chance of addiction. Teens and college students who have not been diagnosed with ADHD have also started using these stimulants to increase their attention span with hopes of attaining better grades. These medicines often come in four concentrations – 10mg, 20mg, 30mg, and 60mg; another sub-variation is between the XR (i.e. extended release) and IR (i.e. instant release). The concentrations determine the strength of the drug whereas the sub-variations denote the duration of its effects. XR capsules have a life of 10 – 12 hours whereas IR tablets have a life of 5 – 6 hours. Depending on the intensity of ADHD, different variations of these medications are prescribed appropriately (Attention deficit hyperactivity disorder (ADHD), 2016).

However, these come with a large set of short and long-term side effects to the brain as well as daily life. Since stimulants control or amplify the activity of blood vessels and the heart; cardiovascular problems are becoming more common amongst regular users. In the long term, abuse of these stimulants also affects the functioning of the liver. Other side effects that cause problems in daily life are sleep issues due to a fast pacing heart, loss of appetite which further leads to headaches and stomachaches, rebound and withdrawal symptoms such as moodiness and irritability due to the risk of addiction.

Non-stimulant Medical Treatment

            There are non-stimulant alternatives also available for the treatment of ADHD symptoms. Atomoxetine is a norepinephrine reuptake inhibitor popularly sold in the market with the brand name Strattera. Norepinephrine is an important neurotransmitter in the brain associated with attention span, emotions, sleeping, dreaming and learning (Daigen, 2012). One of the benefits of these medications is that it doesn’t cause the usual side effects caused by the stimulants. Namely, the side effects avoided by using atomoxetine are agitation, lack of appetite, and difficulty sleeping. However, the FDA and the Medicines and Healthcare Products Regulatory Agency (i.e. the British version of FDA) have recorded several incidents of seizers and heart problems. (Harvard Health Publishing, 2016). Another positive aspect of this non-stimulant medication is that it does not have the same high risk of abuse and addiction as amphetamine-based or methylphenidate-based medications. In one study, children and adolescents reported: “medium” effects from the non-stimulant drug while adults experienced “small” effects compared to the larger effect of stimulants (Bhat, 2016).

Cognitive-Behavioral Therapy

            ADHD is a very complex medical condition and people with this disorder have a higher chance of developing temperamental problems such as anxiety or depression (American Psychiatric Association, 2013). There are two ways in which Cognitive Behavioral Therapy (CBT) is beneficial to a person suffering from ADHD. First, due to the increase in ADHD cases, professionals are regularly developing specific tests to get a more efficient diagnose to fight the disorder more effectively. Second, CBT also helps in fighting the high risk of developing other mental and personality disorders such as anxiety, bipolar and depression (Attention-Deficit/Hyperactivity Disorder (CHADD), 2018). Cognitive Behavioral Therapy in some cases is more effective in the real world as it supports the fact that emotional difficulties are a result of cognitions or automatic thoughts; CBT aims to change these irrational and automatic thoughts that prevent a person from doing any goal-oriented task. All or nothing thinking, overgeneralization, fortune telling, emotional reasoning, mental filtering and comparative thinking are a few prognostic characteristics that CBT tries to reveal and control.

Due to the increase of cases, many psychologists and professionals believe more specific research is still needed. Researchers from Massachusetts General Hospital and Harvard Medical School wrote:

“The conceptual and empirical basis for CBT approaches in adult ADHD is growing and suggests that targeted, skills-based interventions have a role in effectively treating this disorder. At this stage of development, however, subsequent studies must progress in terms of methodological rigor. Additional randomized controlled trials with active control groups are needed and intervention packages must be tested across multiple trials by more than one research group.” (Sherman, Ramsay, Barrow, & Williams, 2018).

CBT’s aim is to help people with the disorder to better deal with daily life impairments. Patients with ADHD have problems in daily life functions such as finding car keys or not being able to control over thinking about something useless. It helps patients to deal with these problems by teaching them techniques to control their undesirable behaviors and be more productive while doing so.

Educational Intervention

            Apart from treating the patient, it is also essential to educate patients and people, especially the ones dealing with the patient directly on a daily basis. School intervention is one example, such as following a daily report card system which further helps the patient to recognize and work towards completion of his/her daily tasks. Parent-Child Interaction Therapy (PCIT), Parent Management Training (PMT) and Positive Parenting Program (Triple P) are a few examples of parent training that have shown positive results (Miller, 2018).  These programs teach parents how to deal with the patient at home and support him/her to help fight the disorder. This results in fewer arguments, tantrums, fights and improved behavior from the child. Additionally, tools like checklists, planners and developing a reward system have also proven to be very beneficial (Miller, 2018). It is natural for parents to be worried about the academic success of their children, especially after the enormous financial burdens. Due to the highly competitive academic culture in colleges today, this generation is exposed to a very high degree of abuse of such stimulants. From my personal experience as a current college student, teens who are not prescribed to these stimulants actively try to get them illegally from their peers who have been prescribed. To cope with ADHD, guardians, and teachers should naturally promote healthy study habits, establish routine study sessions and monitor class attendance. Parents should also sternly educate their children who are prescribed stimulants about the ethical and legal violations of casually distributing these drugs amongst peers and friends.

Conclusion  

In conclusion, there are certain measures that a society ought to take in order to ensure the good health of its people. The most common choice for the treatment of ADHD amongst children today is a hybrid between the use of prescribed medication/stimulants and therapy; undergoing both biological treatment and CBT. This option helps with the biological symptoms of ADHD, by controlling them with prescription drugs; as well as concurrently supporting and promoting effective learning skills and practices through cognitive behavioral therapy (CBT). Since each patient’s needs differ from one another, there is no explicit and clear-cut answer as to which treatment option is best for any one patient. Whether the choice is made through trial and error or by a knowledgeable decision, it is crucial, especially, for patients and parents to be educated and informed about the causes, effects and different treatment alternatives for ADHD.

The content below is solely information base and should not be considered as a substitute to professional medical advice.

References

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The content below is solely information base and should not be considered as a substitute to professional medical advice.