The Real Deal with ADHD
We often hear people say that they think they may have ADHD if they are having trouble focusing on school or work. ADHD is a well known diagnosis that people may misinterpret or misdiagnose.
If you have ever wondered if you may have ADHD, it’s always best to speak to a doctor. However, here is some background on the topic in order to help those that are curious.
Etiology is unknown, however there are suggested contributing factors including:
Genetic factors - higher occurrence in monozygotic twins than in dizygotic twins, 2X the occurance in siblings of hyperactive children. This leads us to believe there’s a correlation in passing it down in families.
Neurological factors - possibility of minimal brain damage due to circulatory, toxic, metabolic, or mechanical effects during fetal development, and infection inflammation, and/or trauma during early childhood.
Neurochemical dysfunction related to neurotransmitters in the adrenergic and the dopaminergic systems.
Psychosocial factors - stress, anxiety, or predisposing factors such as temperament.
According to the American Psychiatric Association (APA) there are three types of ADHD as defined by Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). There are three subtypes of ADHD; Predominantly Inattentive type, Predominantly hyperactive-impulsive type, and Combined type. Depending on the symptoms, your doctor will be able to diagnose your subtype.
Symptoms
Symptoms are often noticed during the early childhood years before 3 years of age. However, caution is advised on early diagnosis and will most often be made during elementary school years when behavior is interfering with school performance. Some other notes on symptoms:
Occurs in 5%-8% of elementary school aged children.
Prevalence in boys to girls is a 3:1 ratio, most common in first born boys.
Partial remission may occur in ages 12-20. Hyperactivity may disappear during these years to allow for a productive adolescence but distractibility and impulsivity can persist.
Symptoms persist into adulthood in 60% of cases.
Diagnostic Criteria
Presence of 6 or more symptoms are required in three Domains (or subcategories).
Symptoms in the inattention/hyperactivity domain that interfere with occupational activities are present for at least 6 months.
Inattention Domain Symptoms may include: lack of attention to detail, poor listening, limited follow through of tasks, difficulty with organization, and avoidance of tasks that require sustained attention, tendency to lose things, distractibility, and forgetfulness.
Hyperactivity Domain Symptoms may include: fidgeting, inability to remain seated, inappropriate activity level for a given situation, difficulty with quiet sedentary activities, frequent movement and excessive talking.
Impulsivity Domain Symptoms may include: answering questions before they are fully stated, difficulty with turn taking, and interrupting the conversations of activities of others.
Other symptoms that may be present: Visual-perceptual, auditory-perceptual, language, cognitive problems.
Some of the symptoms presented were evident before the age of 7.
Symptoms result in difficulty in 2 of these settings: school, home, and/or work.
Symptom management
Medication as prescribed and monitored by a doctor, Psychotherapy, behavior modification, parent and individual counseling may be indicated.
Impacts on function
Infants may be overactive, difficult to soothe when crying, and demonstrate poor sleeping habits.
You may see defensiveness to environmental stimuli, frequent irritability, aggressive behavior, emotional lability, and unpredictable performance. These are all in response to difficulty with attention, it creates a barrier to learning and performance.
There may also be disorders in school related tasks or learning disabilities, which can be assisted with a team approach to your child’s care at school.
Caregivers may also see an increased risk for depression due to frustration and difficulty with learning. Checking up and addressing your child’s self esteem is important during this time to avoid progression. Those with symptoms remaining in adolescence and adulthood are at an increased risk of antisocial personality disorders, and substance-related disorders.
Considerations for Occupational Therapy
Occupational Therapists will work with children and their families on behaviors that may contribute to difficulty in school, play/leisure, and social participation. This may include environmental modification for facilitated learning, training in social skills/self-management, promotion of sensory modulation. Consultations to family, teachers, and employees regarding strategies are also implemented for treatment.
If you have any questions, please feel free to reach out to me directly smplytherapy@gmail.ccom
References
Glanzman, M. M., & Nathan J. Blum. (2007). Attention deficits and hyperactivity. In M. L. Bathshaw, L. Pellegrino, & N. J. Roizen (Eds.), Children with Disabilities, 6th ed. (ppp. 345-365). Baltimore, MD: Paul H. Brooks
American Psychiatric Association. (2000). DSM-IV-TR: Diagnostic and statistical manual of mental disorders, text revision, 4th ed. Washington, DC: Author.