ADHD

WHAT IS ADHD?

ADHD is a neurodevelopmental disorder. It can start early in life and have a persistent course. It is associated with lasting changes in neural development and frequently accompanied with subtle delays, language problems, social and motor developments which overlap with other disorders such as Autism spectrum disorder (ASD) and specific learning disorder. [1]

ADHD has two dimensions which contain different behavioural and cognitive impairments [1]:

Inattentive (Ina): academic difficulties and peer neglect.
Hyperactive-impulsive(H-i): aggressive behaviour and peer rejection.

RISK FACTORS [3]

Family history: having a first degree relative with the same disorder or another mental disorder related to ADHD.
Exposure to certain neurotoxins such as lead.
Drug use, smoking and alcohol use while pregnant: this disrupts the development of the brain of the child.
Premature birth.
Head injuries at a young age, especially the frontal lobe area that controls impulses and emotions.

SIGNS AND SYMPTOMS [2]

*One can present with a combined (both inattentive and hyperactive-impulsive), predominantly hyperactive-impulsive or predominantly inattentive picture*

Persistent form of inattention or hyperactivity-impulsivity that interferes with daily functioning or developments. This includes interference or reduction in the quality of social, academic or occupational functioning.
Children need six symptoms for six months; adolescents and adults need at least five symptoms.
1. Inattention (Ina):
  - Careless mistakes.
  - Cannot sustain attention.
  - Does not seem to listen.
  - Avoids tasks that require continuous attention.
  - Difficult in organising tasks.
  - Fails to finish school work.
  - Loses things for tasks or activities.
  - Destructed by irrelevant stimuli.
  - Forgetful in daily activities such as chores or paying bills.
2. Hyperactivity-impulsivity (H-i): Children need six symptoms for six months; adolescents and adults need at least five symptoms.
  - Fidgets a lot: taps hands and/or feet or squirming when seated.
  - Leaves seat when should be seated.
  - Runs and climbs at inappropriate times.
  - Excessive talking.
  - Always “on the go” or acting as “driven by a motor”.
  - Not able to play quietly.
  - Before a question is completed, blurts out the answer.
  - Difficulty waiting for their turn.
  - Interrupts or intrudes on others.
Numerous inattentive and/or inattentive-impulsive symptoms present before 12 years of age.
Numerous inattentive and/or hyperactive-impulsive symptoms present in two or more setting, that is, at home, school or work.

COMPLICATIONS [3]

Struggling to concentrate in school which may lead to academic failure and judgment by peers or others.
Have a tendency to have more injuries and accidents.
May have low self-esteem.
Tend to have trouble interacting with others.
Have a high risk of alcohol and drug abuse or other offending behaviours.

LIFESTYLE MODIFICATIONS [3;4]

Limiting screen time: this includes computer screen, television screens, iPads, phones, etc.
Talk to the doctor about behaviour therapy programs.
Limit sugar, whether it be in beverages or food.
Drink plenty of water: water can be taken instead of sugary beverages such as juices, soft drinks, energy drinks, alcohol, etc.
Sensation of smoking.
Get plenty of sleep: set up a sleep routine for yourself.
Drink medication as directed by the doctor. Set up reminders if need be.
Do not miss any doctor appointments.

IMPACT OF ADHD ON THE FAMILY [1]

They may be marital conflict due to physical, emotional and financial strain.
Financial burdens: from doctor visits, education or unable to sustain employment, medication and other therapies.
Strained parent and other children relationships: as they may feel one child is getting more attention and not being disciplined to their extent.
Working parents may not have time to monitor their children all the time which can increase the probability of the child being involved in offensive behaviours such as smoking or drug and alcohol abuse.
Aggressive behaviour causing strained relationships in the immediate or with distant family members.
Sibling rivalry due to physical and/or emotional aggression.
Family members may develop mental or emotional disorder due to all the strain.

SUPPORT TECHNIQUES [1]

Parent management training which can reduce parent-child conflict and disruptive behaviour, promote social and self-regulating behaviours.
Family counselling: where they will educate the family on coping with individual and family stresses related to ADHD including mood disturbances and marital strain.
Support groups which can help connect parents with other parents of children with ADHD or connect people with ADHD, sharing information and experiences.
Individual counselling which can help address individual concerns and feelings.

REFERENCES

Burns, J. Roos, L. 2016. Textbook of Psychiatry for South Africa. 2nd edn. South Africa: Oxford University Press.
Renynolds, C. R. Kamphaus, R. W. Attention-Deficit/Hyperactivity Disorder (ADHD). America: Pearson; 2013.
Mayo Clinic Staff [Internet]. Attention-deficit/hyperactivity disorder (ADHD) in children. America: Mayo Clinic; [updated 2019 Jun 25; cited 2019 Aug 19]. Available from: https://www.mayoclinic.org/diseases-conditions/adhd/symptoms-causes/syc-20350889.
Preidt, R. [Internet]. Lifestyle may be key to improving ADHD in kids. America: WebMD; [updated 2016 May 30; cited 2019 Aug 19]. Available from: https://www.webmd.com/add-adhd/childhood-adhd/news/20160530/lifestyle-may-be-key-to-improving-adhd-in-kids.
disAbilityNavigator [Internet]. ADHD and Risk of Injuries. America: Centers of Disease Control (CDC); [updated 2018 Oct 01, cited 2019 Sep 09]. Available from: https://disabilitynavigator.org/article/12630/adhd-and-risk-injuries.
Sinfield, J. [Internet]. An overview of living with ADHD. New York:verywell mind; [updated 2019 Sep 02; cited 2019 Sep 09]. Available from: https://www.verywellmind.com/adhd-overview-4157275.