Attention deficit hyperactivity disorder

**Attention-deficit hyperactivity disorder** (**ADHD**) is a neurodevelopmental disorder. It affects how people think and act.

People with ADHD may have trouble sitting still, being quiet, or sleeping. They may be rather impulsive.
They usually have problems focusing and remembering what is said or done around them, causing problems in school, work, and relationships if not properly managed. However, they can focus extremely well on interesting or urgent tasks, often longer and more intensely than those without the condition. This is called hyperfocus, and is a potential benefit and drawback depending on the context. ADHD is called a _neurological developmental disorder_ because it affects how people's nervous systems develop.

Experts think that, throughout the world, about one in twenty children (5%) have ADHD. Some countries have more people with ADHD than others, and not everyone uses the same tests. Psychologists have found more people with ADHD in North America than in Africa and the Middle East. In the United States, about one in every fourteen children has ADHD (7%), including one in every ten boys (10%) and one in every twenty-five girls (4%). This could be because more boys get ADHD, or because fewer girls take ADHD tests.

ADHD is most diagnosed in children and especially in boys. However, it is not uncommon for teenagers or adults to be diagnosed with ADHD. ADHD has no cure which means it is permanent. However, people with ADHD can treat it which means to help them get better. The difference between a cure and treatment is a cure entirely removes a problem, while the treatment does not remove the problem but help make the symptoms go away as if you don't have ADHD.

## Signs and symptoms

People with ADHD can have trouble paying attention, be overly active, or be impulsive. There are three types of ADHD, based on which of the three symptoms are most common.

Someone who usually has trouble paying attention may have some or all of these symptoms:

- They can have difficulty focusing

- They can get distracted easily when listening
- They can get bored after a few minutes unless it's something they enjoy
- They can have difficulty when organizing or completing a task, homework, assignments, and by handing in tasks
- They can often lose items or forget about them
- They do not seem to listen when they are spoken to
- They can daydream, become confused easily, and not move fast
- They have difficulty taking information quickly or correctly
- They seem to struggle when following instructions
Someone who usually is overly active may have some or all of these symptoms:
- They may move around a lot when sitting.
- They may talk without stopping.
- They may run around touching or playing with anything they see.
- They may have trouble sitting without moving while trying to eat, do homework, or pay attention in class.
- They may move constantly.
- They may have trouble doing things quietly.
- They may have tics (like Tourette syndrome) that are caused by panic or stress.
People who are overly active usually lose these symptoms as they get older.

Someone who usually is impulsive may have some or all of these symptoms:
- They may be very impatient.
- They may say things that are not nice or correct or do things without thinking about what will happen.
- They may have trouble waiting for things they want to have or do.
- They may often interrupt other people.
People with ADHD may have trouble making and keeping friends. They may also have trouble controlling their anger. While children with ADHD may have trouble doing some things, many children with ADHD will not have trouble paying attention to something they enjoy or think is interesting.

It is not uncommon for ADHD to be diagnosed jointly with one or more neurodevelopmental disorders, known as comorbidity. It is most often paired with Autism Spectrum Disorder (ASD), a variety of learning disorders (LD), and depression. Specifically in terms of comorbidity with ASD, these patients tend to have more severe symptoms than if they were only diagnosed with one of the conditions. With regards to depression, researchers found that youth diagnosed with ADHD were associated with higher rates of depression that youth without it.

Other mental disorders diagnosed with ADHD include oppositional defiant disorder, conduct disorder, dyslexia, Tourette syndrome, anxiety disorders (especially obsessive-compulsive disorder), mood disorders, substance use disorders, eating disorders and personality disorders (especially antisocial, borderline, histrionic, passive-aggressive and avoidant).

## Cause

It is believed that the main difference between neurotypical brains and the ones with ADHD is the deficit in the amount of dopamine receptors within the synapses in the brain. This deficit is said to be the main factor in regulating motivation and sustaining attention.

Research of twins has shown that about three in four cases of ADHD are caused by one or both parents having ADHD. Siblings of children with ADHD are three to four times more likely to develop the disorder than siblings of children without the disorder. Genetic factors are also believed to be involved in determining whether ADHD lasts into adulthood. Some scientists think that ADHD is common because when humans were first developing, it was good to be overly active. Others think that, because ADHD is more common in children when the mother is anxious, ADHD developed to help children in dangerous places.

There are other possible causes for ADHD. If a pregnant person drinks alcohol, it can cause fetal alcohol syndrome, which can include ADHD. ADHD can also happen if a mother smokes tobacco while she is pregnant. Lead, low birth weight, premature birth, and some infections can increase the risk of a child having ADHD.

## Diagnosis

The most commonly used rating scales for diagnosing ADHD are the Achenbach System of Empirically Based Assessment (ASEBA) and include the Child Behavior Checklist (CBCL) used for parents to rate their child's behavior, the Youth Self Report Form (YSR) used for children to rate their own behavior, and the Teacher Report Form (TRF) used for teachers to rate their pupil's behavior. Additional rating scales that have been used alone or in combination with other measures to diagnose ADHD include the Behavior Assessment System for Children (BASC), Behavior Rating Inventory of Executive Function - Second Edition (BRIEF2), Revised Conners Rating Scale (CRS-R), Conduct-Hyperactive-Attention Problem-Oppositional Symptom scale (CHAOS), Developmental Behavior Checklist Hyperactivity Index (DBC-HI), Parent Disruptive Behavior Disorder Ratings Scale (DBDRS), Diagnostic Infant and Preschool Assessment (DIPA-L), Pediatric Symptom Checklist (PSC), Social Communication Questionnaire (SCQ), Social Responsiveness Scale (SRS), Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Rating Scale (SWAN). and the Vanderbilt ADHD diagnostic rating scale.

The ASEBA, BASC, CHAOS, CRS, and Vanderbilt diagnostic rating scales allow for both parents and teachers as raters in the diagnosis of childhood and adolescent ADHD. Adolescents may also self report their symptoms using self report scales from the ASEBA, SWAN, and the Dominic Interactive for Adolescents-Revised (DIA-R)

Based on a 2024 systematic literature review and meta analysis commissioned by the Patient-Centered Outcomes Research Institute (PCORI), rating scales based on parent report, teacher report, or self-assessment from the adolescent have high internal consistency as a diagnostic tool meaning that the items within the scale are highly interrelated. The reliability of the scales between raters (i.e. their degree of agreement) however is poor to moderate making it important to include information from multiple raters to best inform a diagnosis.

## Managing ADHD

There is no cure for ADHD. People with ADHD can be helped with therapy or medication. Therapy is recommended for children who do not have bad symptoms or are very young. Therapy for people with ADHD helps with attention and behavior. There is also education for parents and teachers to help children with ADHD. Some physical exercise has been shown to help people with ADHD.

Generally, its treatment is categorized into two categories i.e. pharmacological and nonpharmacological. The first line treatment for ADHD includes cognitive behavioral therapy and use of stimulants. While cognitive behavioral therapy (CBT) programs were once thought to be the solution for working with ADHD children and getting them to slow down and think, sadly, CBT programs have not been proven to be an efficient strategy for working with ADHD populations.

Stimulants increase the amount of a chemical called dopamine in the brain, which helps with paying attention, planning, organization, and management of being overly active. These medications should not be given to children below the age of 6.

## Society and culture

People do not agree about the diagnosis of ADHD. The number of people with ADHD has increased in the last several years. Some people think this is because doctors are diagnosing too many people. Others think it is because doctors are getting better at finding people with ADHD. Some people think that ADHD is made up and not a real illness, even though it's the most researched condition in psychiatry. Most studies suggest that ADHD is mostly caused by problems with genes.

Several famous people have spoken about the rise in ADHD diagnoses. Actor Tom Cruise said that the medicines usually given to people with ADHD were like illegal drugs. Others disagreed with him because the amount of medicine given to people with ADHD does not cause addiction. There have been many studies about the effectiveness of the medicines used with ADHD. One certain study found that the medicine did help over a long time, but did not help more than other types of treatment.

## Further reading

- Genetics links between five major psychiatric disorders: autism, ADHD, bipolar disorder, depression, and schizophrenia per recent study.
- _5 Disorders Share Genetic Risk Factors, Study Finds_ February 28, 2013 The New York Times
- _Psychiatric Disorders Linked Genetically_ February 27, 2013 WSJ
- ADHD Screening Test March 10, 2018