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ADHD 101: Symptoms, Causes, Diagnosis & Treatment

Updated: Nov 22, 2022

Reblogged from: Homage Malaysia


Attention-deficit/hyperactivity disorder, or better known as ADHD, is a common neurodevelopmental disordera medical condition resulting from abnormalities in the brain that affect the brain functions primarily attention, self-control, and complex thinking ability. It is often discovered among school-aged children as early as the age of 6, but may also prolong into the stage of adolescence and adulthood. Although the level of severity can start off mild, it can extend to being chronic if left undiagnosed and untreated. ADHD has a higher risk of comorbidity, which means it may present together with other disorders such as depression and anxiety. As of 2014, Malaysia reported a prevalence rate of 3.9%, not including undocumented cases which are expected to be a large number.



ADHD Symptoms and Types

Symptoms of ADHD can be categorised according to the following types as laid out by the American Psychiatric Association:


Primarily inattentive

If you have this type of ADHD, you may find yourself grappling with getting attention fixed on one thing and following through basic daily tasks. Girls are more likely to be diagnosed with inattentiveness, a more subtle trait. There are 9 common symptoms including:


1. Getting distracted easily especially by other unimportant sounds, views or movements in the surroundings.

2. Slipping out on small details resulting in carelessness and frequent mistakes.

3. Unable to focus during lengthy activities such as long conversations, classes, extensive reading, and tutorials.

4. Is often not present in the moment to engage successfully in verbal exchanges such as talks and discussions.

5. Doing tasks halfway or having troubles completing them, due to instantly losing focus after only a few minutes of starting.

6. Struggling with organising tasks, which results in messy time planning.

7. Regularly being forgetful of necessities such as wallet, keys, mobile phone, and stationeries.

8. Losing track of chores that requires commitments like schoolwork, paying bills, appointments, and meetings.

9. Avoiding tasks that involve continuous mental effort for example studying, brainstorming, preparing paperworks, and complex decision-making.


Primarily hyperactive-impulsive

This type of ADHD is identified by two characteristics namely hyperactivity and impulsivity. Both are often grouped together as ‘hyper’, relating to motor control problems and defiant behaviors which directly impacts society at large. Boys are more likely to have this category of ADHD due to their nature of acting out. Here are the 9 observable general symptoms :

Hyperactivity

1. Fidgeting or making little movements with their hands, limbs and feet.

2. Unable to stay still while standing or seated.

3. Incapable of playing in a quiet and disciplined manner.

4. Always moving about aggressively such as climbing, running around, and touching things even in inappropriate situations.

5. Constantly in motion physically and bursting with overflowing active energy.

6. Talking continually all the time and verbally on the go.

Impulsivity

7. Being impatient in waiting for their turn.

8. Interrupting others particularly while speaking or playing, which violates social ethics.

9. Often blurting out, speaking and doing things without thinking about consequences.

The combined type

This is the most common and widely recognised type of ADHD whereby you exhibit a combination of symptoms of both inattentive and hyperactive-impulsive types.


ADHD vs. ADD


Is there a difference between the two? Actually, no.


ADD stands for Attention-Deficit Disorder, an outdated term used before hyperactivity was included. Even so, both terms are still used interchangeably with ADD referring to the primarily inattentive type of ADHD.


Children and Adults with ADHD

More often than not, ADHD symptoms are quite similar between children, teens, and adults. In most cases, the symptoms carry on from childhood but resurfaces in different forms once they become adults due to changes in social settings and interventions.


In children

Signs of ADHD in children often go undetected until they start attending formal education in schools, where academic performance reflects obvious delayed progress as compared to other students of the same age. Some instances of ADHD in children are:


● Not paying full attention during class.

● Lack of listening causes them to overlook instructions by teachers.

● Fail to complete tasks in classroom and schoolwork.

● Unable to show cooperation in group activities and playtime.

● Blurting out irrelevant answers before the teacher can finish their questions.

● Abruptly cutting off interactions of fellow students.

● Aggressive behaviors and frequent movements can disrupt a class in session.

● Often leaving basic chores unfinished, adding up the mess at home.


In teenagers and adults

Symptoms in older teenagers and adults are suspected to be underreported as they typically manifest through non-physical signs instead of aggressive behavior, which are less noticeable. What makes it worse for adults with ADHD is that they are not aware of having it, with people around them constantly dismissing their symptoms as plain recklessness or attitude problems especially at the workplace. As the symptoms continuously being kept suppressed, they can give rise to more grave mental health issues. This in turn may lead to dependence on smoking, alcohol, and substance abuse. Examples of ADHD in adults are:

● Having trouble multitasking and prioritising, resulting in missed deadlines.

● Unable to submit assignments on time as a result of concentration problems.

● Poor decision-making due to impulsivity and lack of attention to details.

● Difficulty in coping with stress and pressure.

● Employment is threatened due to unsatisfactory academic or work performance.

● Inability to abide by social codes can cause professional and personal relationships to be on the rocks.

● Constant mood swings, with anger and frustration typically interfere.

Being criticised as problematic may affect self-esteem issues.


Cause and Risk Factors of ADHD

Until today, researchers are yet to discover the definite cause of ADHD despite an exhaustive list of studies already being conducted. When it involves changes or impairments in the brain, it is rather difficult to pinpoint precise causes as opposed to how physical defects do. This is because mental health issues including ADHD, involves a combination of various aspects that can contribute as risk factors, mainly being the following:


Genetics

A study reported evidence that ADHD is more likely to be inherited from parents or blood-related families who also have ADHD. Research reveals a higher percentage of ADHD found in biological parents and siblings with a rate of 18% and 31% respectively, as compared to adoptive parents and adopted children with the rate of only 6% and 8%. According to the National Human Genome Research Institute, at least one-third of all fathers who have or had ADHD when they were young, have children with ADHD. In addition, most identical twins have a greater likelihood to be diagnosed with ADHD due to sharing of the same genes which reaffirms that genetics play a significant role.


Environmental causes

There are individuals living with ADHD even though their family members and relatives have no history of the disorder. This is where environmental factors are weighed in, which is the possibility of exposure to hazardous chemicals during pregnancy and childhood stage.


A study carried out in 2016 found that a type of toxin, namely lead, even when used at a low concentration is able to alter the dopamine functions, which covers motor or movement control, cognitive development, emotions, and motivationall of which critically add to the risk of ADHD.


Brain injury and structure

Young children who suffer from traumatic brain injury are described to have higher chances of ADHD later in life, due to damages inflicted upon the brain that may impair their attention abilities.


Other than that, abnormal brain structure may also be a contributing cause. According to findings in a scientific journal, it is described that those with ADHD have a smaller size of gray matter which is responsible for muscle control and sensory activities like seeing and hearing, memory, as well as speech.


Premature pregnancy

Another research reported that babies who are born prematurely or weigh too little might have twice the risk of ADHD diagnosis. This is because early delivery can disturb the normal development process of the central nervous system, comprising the brain and spinal cord that heavily serves information processing ability and body movement.


Alcohol consumption and drug use during pregnancy

Alcohol consumption and drug use are known to induce many disabilities in children. When you are pregnant, anything you consume and take will directly affect your fetus in the womb. Drugs such as marijuana and heroin can lead to physical and mental retardation, while alcohol results in impairments in the central nervous system.


Diagnosing ADHD

If you start to notice unusual behaviors in your children, you may bring forward your concerns to a General Practitioner (GP) or nearest family physician for a general consultation. If they suspect a presence of ADHD symptoms, they will refer you to a specialist for further assessment which may consist of physical examination, interviews with you or loved ones, parent-child interactions, background check on medical and family history, along with performance at home or in public.


It is argued that ADHD is not likely to appear for the first time in adults, unless they have ongoing symptoms of ADHD but were not diagnosed as a child. This is because ADHD in adults is mainly a result of unidentified symptoms extending from childhood For that reason, the specialists will go through your academic and work progress in the past, as well as observations shared by close relatives before confirming diagnosis.


In order for health professionals to clinically diagnose you with ADHD, you must fulfill the following criteria:


● Symptoms begin before the age of 12 for children.

● Symptoms displayed in more than 1 settings either at home, school, work, or in public spaces.

● Symptoms disrupt everyday life functioning, relationships, academic and job performance

● Exhibit at least 6 out of the total 9 symptoms from each of the inattentive and hyperactive-impulsive types

● Exhibit a combination of 6 or more symptoms of inattentive type, and another 6 or more of hyperactive-impulsive type.


Self-diagnosis based on assumptions and generalised information gathered online, from medical resources or common experiences is extremely discouraged. There is a possibility of identifying with the wrong disorder and treatments that can be detrimental to your health. Do seek verification from specialists especially for mental health conditions.


ADHD Treatments

As ADHD is a complex disorder, treating and managing it requires multimodal effort of blending multiple approaches and interventions to achieve one ultimate goal—to reduce symptoms as much as possible so that it no longer interferes with your daily life. What works for you or your child might not work as effectively for other people. This involves teamwork and support mainly between parents, family members, teachers, and health professionals.

Psychotherapy is very useful in modifying existing ways of thinking and behaving to be more positive, instead of letting them be shaped by societal judgments and self-esteem issues. This kind of therapy can accommodate people with ADHD that suffers co-morbidity such as depression and anxiety to rebuild their confidence due to feelings of alienation. Psychotherapy can be practised through several methods such as cognitive-behavioral therapy and behavior therapy.


Behavior therapy focuses on managing uncontrolled behaviors through a system of rewards as a way of increasing motivation and instilling a sense of discipline. The aim is to encourage positive conduct and reduce negative or unwanted behaviors. This method is more recommended for children as they are unaware of their own physical aggressiveness and social rules, hence the major role of family members and teachers is crucial.


Cognitive-behavioral therapy is an advanced form of behavior therapy usually advised for older teenagers and adults. It helps to guide in understanding your inner thoughts and perceptions to make sense of your behavior patterns. You will discover how your thoughts, feelings and actions can influence one another before being introduced to several training strategies by licensed psychiatrists or psychologists to manage them properly. On top of that, these specialists will also encourage you to unpack any suppressed emotions so that you are able to express and convey them more articulately. Once you learn how to think mindfully, communicate clearly and overcome impulsiveness in making decisions, personal and work relationships can improve vastly.


Medication

Taking medication is not a quick fix for ADHD as it is not a one-time relief and commonly integrated with therapies. It does, however, reduce the severity of symptoms so that they are more manageable and under control. Specialists would typically recommend stimulants or non-stimulants to boost the level of dopamine hormones in the brain, which improves concentration and better regulates impulsiveness.


It is important to consider that most medications come with side effects, including those of ADHD. Each person has different needs and limitations, therefore work together with your doctor to seek medical advice on what kind of medication is most suitable, alongside the potential side effects based on your diagnosis before making the best decision for yourself or your child.


Education

One of the triggers that worsens the symptoms of ADHD is lack of awareness and ignorance. In Malaysia for example, there is still a lack of understanding among parents who perceive their kids as embarrassing to the family. Mental health disorders in general are often looked down on and not being taken seriously because such invisible illnesses are assumed as overreacting or unstable. When you are regularly being ridiculed, it does not take a long time before you end up believing themthat there must be something wrong with who you are. Hence, being educated through educational and training programmes can go a long way to destigmatize ADHD.


Early intervention

Once your loved ones are well-informed about the basics of ADHD, spotting symptoms early becomes easier and helps in speeding up the process of diagnosis. Interventions that start from a young age such as establishing routines and habit training can reduce severity so that it may subside as you grow up.


Living with ADHD

Navigating life while living with ADHD can be challenging, not only for yourself but also for your loved ones. It can be quite testing at the beginning when you are still trying to learn coping with this unfamiliar health condition. However, once you manage to adapt by practising the same strategies every day and being assisted to dive deep into your inner conflicts, the tough days will hopefully become effortless. It takes some time to find what practices work for you best; be it exercising, yoga and meditation, listening to music, keeping a journal or utilising organisation mobile apps. Everything is a trial and error process, one that requires unwavering persistence and hope.


ADHD Support Group

Most guidance and directions related to ADHD management caters for handling young infants with ADHD, due to it being common among children. This leaves adults with ADHD as well as loved ones and educators to be at loss in coping with their own struggles, which often go unrecognised. Joining a support group can be a great long-term investment in terms of finding a sense of belonging, encouragement, inspiration, and assistance to persist through the journey of managing ADHD. There are numerous support groups that specialise in different needs such as learning strategies at school and ways to establish routines at home.


Nowadays, support groups are conducted by either specialists or people who have experience with ADHD management available in both face-to-face mode and online. Here is a list of centres across Malaysia that you can look out for, apart from the following informational websites


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References


ADHD Institute. (2021, March). ADHD Epidemiology. https://adhd-institute.com/burden-of-adhd/epidemiology/


Bonath, B., Tegelbeckers, J., Wilke, M., Flechtner, H. H., & Krauel, K. (2018). Regional Gray Matter Volume Differences Between Adolescents With ADHD and Typically Developing Controls: Further Evidence for Anterior Cingulate Involvement. Journal of attention disorders, 22(7), 627–638. https://doi.org/10.1177/1087054715619682


Centers for Disease Control and Prevention. (n.d.). Symptoms and Diagnosis of ADHD. https://www.cdc.gov/ncbddd/adhd/diagnosis.html


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Hallowell, E. (2019, October 8). Your ADD Life: ADHD Support Groups. ADDitude. https://www.additudemag.com/your-add-life-adhd-support-groups/


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Dr. Lennie Soo

Founder and Clinical Director of 360 Wellness Hub.

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