Why And When Do We Need To Treat ADHD
If most of your some days make you feel hopeless and that life has no meaninglifeless, you might be suffering from major depression. Do not worry because and trust me, you are not alone in this.
- Constantly fidgeting?
- Excessive talking?
- Excessive physical movement?
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Start With Your Primary Care Doctor
Talking to a professional is the first thing you have to do if you or your child is showing symptoms of Attention Deficit Hyperactivity Disorder or most commonly known as ADHD or ADD. You may consult the following professionals for they have experience in assessing and treating ADHD through a thorough assessment.
- Psychiatrists
- Psychologists
- Psychiatric Nurses
- Social Workers
Diagnosing ADHD
ADHD is diagnosed by exclusion, a diagnosis reached by a process of elimination, because disorders such as anxiety, sleep, or depression have similar symptoms.
The American Academy of Pediatrics (AAP), American Psychiatric Association (APA), and the American Association of Child and Adolescent Psychiatry (AACAP) released a guideline on how healthcare professionals should make the diagnosis. They must ask the patient, the parents, the teachers or any adults who interacted with the patient about the behavioral changes of the patient in at least two areas – at home and at school (for school age children).
ADHD and Executive Function
ADHD is generally thought of as a disorder of executive function. People with this disorder tend to show a decline in cognitive control of their behavior. In terms of reacting to insignificant external or internal stimuli, their reaction is much lower compared to normal. Based on studies, their MRI studies show a thinning of the cortex in the areas linked to working memory and attention. (Molecular Neuropharmacology; Nestle, Hyman 321-323)
Diagnosis is based on the criteria of Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM 5). You can find below a brief summary of the criteria.
Note: This information is solely for education purposes only and can therefore not be used for any form of self-diagnosis. Consult your trained health care providers for proper diagnosis and treatment.
What to look out for
DSM-5 Criteria for ADHD
People with ADHD have a persistent pattern of inattention and/or hyperactivity and impulsivity behavior that significantly interferes with functioning and development in the following areas:
Inattention: For children up to age, six or more symptoms might show. For age 17 and older adolescents, five or more may be evident. For adults, symptoms may persist for at least 6 months, thus be inappropriate for developmental level.
- Failure to give close attention details
- Carelessness behavior in school, work, and other activities
- Difficulty in being attentive to tasks
- Difficulty in listening when directly spoken to
- Failure to follow instructions and to finish schoolworks, chores, and responsibilities
- Difficulty in organizing tasks, and activities
- Difficulty in retaining information
- Avoids tasks that require mental efforts over a long period of time
- Loses necessary things for activities (pencils, books, tools, eyeglasses, mobile phones, etc)
- Easily distracted
Hyperactivity and Impulsivity: For children up to age, six or more symptoms might show. For age 17 and older adolescents, five or more may be evident. For adults, symptoms may persist for at least 6 months, thus be inappropriate for developmental level.
- Fidgeting (tapping hands or feet, squirming)
- Leaving seat in situations he/she is supposed to remain seated (class discussions, busy office hours)
- Running and/or climbing in appropriate places
- Unable to do tasks quietly
- Acting “on the go” as if driven by a motor
- Excessive talking
- Blurting out answers before completing the question
- Difficulty in waiting for his/her turn
- Interrupting conversations, or others’ tasks
Moreover, the following conditions must also be met:
- Presence of several symptoms of inattention and/or hyperactivity and impulsivity before the age of 12.
- Presence of several symptoms in two or more areas (home, school, work, friends or relatives)
- Clear evidence of symptoms interfering with social and cognitive function.
- Symptoms cannot be classified under other mental disorders (anxiety disorders, personality disorder, and such). Symptoms must not occur only during schizophrenic episodes or other psychotic disorders.
Support
Family support is the best option when helping somebody who experiences depression. Some of them might only want someone to talk to and wanted to feel that they have a companion who is willing to understand and feel their situation.
Types Of ADHD
There are three kinds or presentations of ADHD that can occur based on the types of symptoms.
Combined Presentation
Combined Presentation: If several symptoms of inattention and hyperactivity and impulsivity are present for the past 6 months.
Predominantly Inattentive Presentation:
Predominantly Inattentive Presentation: If several symptoms of inattention only are present for the past 6 months.
Predominantly Hyperactive-Impulsive Presentation:
Predominantly Hyperactive-Impulsive Presentation: If several symptoms of hyperactivity and impulsivity only are present for the past 6 months.
Presentations are subject to change over time as symptoms also change.
ADHD in Adults
ADHD lasts to adulthood. According to Parikh and Baker (2016), around 65 percent of individuals with ADHD as children will develop persistent impairing symptoms by age 25.
Changes In The DSM-5
In may 2013, the fifth edition of DSM was published and immediately replaced the previous versions.There were some modifications in the fifth edition for ADHD diagnosis.
- Symptoms can occur by the age of 12, instead of 6
- Symptoms need to be present in two or more settings
- New descriptions were put in to depict symptoms at older ages
- Only 5 symptoms are needed for adults and adolescents age 17 and older
Obstacles In The Treatment OF ADHD
1. Fear of medication addiction
This is a myth that needs to be debunked. In a published journal of AACAP in 2016, a multi-cohort national study with a sampling of about 40,000 individuals showed that an early start of treatment for ADHD and continuing it for 6 years and more was associated with a lower rate of substance use than of the general population. In addition, those who had treatment later and took medication for less than 2 years showed similarity to the general population’s rate of substance use.
2. Relative Immaturity
Children and adolescents with ADHD are inclined to become less immature compare to their peers at the same age (JACCAP 2016;55(10):886-895). ADHD is more prevalent in males because females are more protected against ADHD development (JAACAP 2016;55(6):504-512).
ADHD Treatment
1. Medication
Amphetamine – may come in short acting or long acting formulations that can be combined based on its responses. It increases the norepinephrine and dopamine release that are extremely important for the frontal brain circuits.
Methylphenidate – may also come in short acting and long acting formulations. Amphetamine and methylphenidate are the two most effective medications for ADHD. However, both have side effects that include: insomnia, decreased appetite, and growth delay. Taking both would enhance and increase the probability for side effects.
Atomoxetine – it also increases norepinephrine release. It is not as effective as a stimulant but it can be used as an alternative for those who have difficulties tolerating amphetamine and methylphenidate.
Bupropion – is a third line of treatment for those who have difficulties tolerating amphetamines and methylphenidate. It can also be added to enhance response.
2. Neurofeedback
Well-controlled studies fell short to show evidence on the role of neurofeedback as an effective treatment. (Cortese and collab JAACAP 2016;55(6):444-455).
3. Brain Training Games
Brain Training games failed to construct evidence that it is linked with ADHD treatment. They are perceived, however, to open new possibilities in the future as they further develop. At of the moment, they are utilized as part of cognitive rehabilitation (Psychiatric Times, June 2014: The Evidence and Application of Brain Training Games: Science or Sales, Larry Brooks).
Myths About The Treatment Of ADHD
There are three myths about treating ADHD according to Strawn (2016).
- 1. Contrary to conventional wisdom that stimulants have the tendency to worsen anxiety, a meta-analysis of about 3,000 patients revealed that stimulants have a low risk for anxiety and many experienced improvement in their anxieties compared to others who had an increase in their anxiety level.
- 2. A meta-analysis of 22 studies, which includes 2,400 patients, demonstrated lack of association between stimulants and a new onset or worsening of tics even though contraindication is stated in the package details
- 3. Polypharmacy, the simultaneous use of multiple drugs to treat a single condition, does not illustrate a treatment failure but is proven to be beneficial- it allows synergistic effects of different medications
Consequences Of Not Treating ADHD
Below are the consequences if ADHD is left untreated according to research.
- 1. Failure in school, peer rejection, and association with delinquents may intensify an individual’s use of substance, notably in the presence of comorbid conduct disorder (Molecular Neuropharmacology, Nestle, Heyman pg 321-323).
- 2. Children and adolescents who have ADHD are predicted to be homeless in adulthood, partly due to significant degree of comorbidities with conduct, SUD, arrest, and school dropouts.(Garcia Murillo and colab/JAACAP 2016;55(11):931-936)
- 3. The severity of ADHD symptoms in adulthood is proportional to how the symptoms were addressed during childhood. Basically, treating ADHD during childhood or adolescence as early as detected may mitigate the symptoms present in adulthood. (Roy and colab JCAAP 2016;55(11):937-944)
- 4. When less ADHD symptoms are present in adolescence, adult functioning tends to become worse (Hechtman, MD and collab/JAACAP 2016;55(11):945-952). It is then therefore highly important to detect ADHD symptoms early and intervene at the right moment to promote better functional outcomes.
- 5. Adults with ADHD are most likely to commit traffic violations and cause accidents, and they have a higher rate of incarcerations and convictions.
- 6. The mortality rate is two times higher than normal along with high tendencies of suicide and accidents. (Parikh, Baker Current Psychiatry 2016, October)
Support
Family support is the best option when helping somebody who experiences depression. Some of them might only want someone to talk to and wanted to feel that they have a companion who is willing to understand and feel their situation.
Does Your Child Have ADD OR ADHD?
ADHD significantly affects the behavior of any age with this disorder. According to a national study done by the CDC, 11% of school-aged children are being diagnosed with ADHD. The three major symptoms of the disorder are inattention, hyperactivity, and impulsivity. If symptoms become severe, enough to draw attention to the behavioral change of an individual and an evident decline in mental or social function, a diagnosis of ADHD is certainly possible.
Children with ADHD/ADD may be classified under the following types:
- Inattentive, but not hyperactive or impulsive
- Impulsive and hyperactive, but is attentive
- Inattentive, hyperactive and impulsive ( which are the most common type of ADD and ADHD)
Not All Children Have Hyperactivity
Children who display the inattentive type of ADHD are frequently neglected in school, work, home or any settings since the depicted behavior is not turbulent. There are some parents or teachers, however, that are able to detect one or more symptoms of inattention due to their difficulties in following directions, turning in homework, getting consistent good grades, or interacting with other children.
Attention Deficit is a Misnomer
Living a life with ADHD does not only portray actions or reactions that are meant to garner attention. It does not necessarily mean bouncing off walls, interfering in every conversation, dancing wildly in the middle of a public gathering or any sorts. Some children who have ADHD display inability to focus, concentrate, and think and even show disinterest in an activity after some time.
Some exhibit hyperactivity, while some just sit peacefully with their thoughts and attention somewhere else. Some unnecessarily exaggerate their focus on a task, and find it difficult to shift their focus on other things while some may exert little to no attention but overly impulsive.
ADHD Symptoms in Children may include
The following are the symptoms you need to look out for in your children:
- Excessive talking
- Failure to constantly finish schoolworks, chores, and other tasks
- Difficulty in waiting for his/her turn
- Easily distracted
- Difficulty in following instructions (remaining in seat)
- Constantly needs to be in motion
- Difficulty in concentrating and paying attention
- Frequent daydreams
- Squirming and fidgeting
- Difficulty in listening
- Intervenes with others’ conversations or activities
Knowing and learning the symptoms may often lead us to hastily self-diagnose but it is recommended and important to consult and be diagnosed by a mental health professional. Symptoms alone won’t guarantee that an individual does have the disorder. A specialist administers tests to determine what disorder the patient has. We highly recommend you to consider first all of your options before proceeding to medications or other forms of treatment to prevent risks.
You can visit this website for a more detailed description of ADHD symptoms in children.
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