A common neurodevelopmental disorder, it calls for comprehensive understanding for effective management.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects both children and adults. It is characterised by difficulties in inhibiting irrelevant stimuli for sustaining attention, stopping hyperactivity, and avoiding impulsive behaviours. It can significantly impact an individual’s daily functioning, academic performance, work productivity, and interpersonal relationships.

As a chronic condition, ADHD affects the brain’s executive functions, including attention regulation, impulse control, and working memory. However, contrary to popular perceptions, it is not a result of laziness, lack of intelligence, or a character flaw.

Causes of ADHD
ADHD is highly hereditary, with a hereditability index of 0.76. Other causes of ADHD are not fully understood yet. Research suggests a combination of genetic, environmental, and neurological factors.

Genetic factors indicate that ADHD tends to run in families, highlighting a genetic predisposition. Neurologically, individuals with ADHD often exhibit differences in brain structure, particularly in regions responsible for attention regulation and impulse control.

Furthermore, environmental factors such as prenatal tobacco smoke exposure, alcohol or drug use during pregnancy, premature birth, low birth weight, and exposure to environmental toxins are being investigated as potential contributors to ADHD risk. Factors such as high sugar intake and increased screentime are not contributing factors though.

What are the symptoms?
ADHD symptoms typically include inattention (being easily distracted by external stimuli), hyperactivity (constant restlessness and fidgeting), and impulsivity (impatience and a tendency to take risks without considering potential dangers).

In most cases, the common comorbidities of ADHD include oppositional defiant disorder (ODD), autism spectrum disorder (ASD), and mood disorders, such as anxiety or depression. Among adults with ADHD, the debilitating co-existing conditions may include migraine and depression, among other things.

How is ADHD diagnosed?

Diagnosis of ADHD involves a comprehensive assessment conducted by healthcare professionals, typically psychiatrists or psychologists. The source of input depends on those who have the most contact with the person with ADHD. The symptoms must be persistent, occur in at least two settings, and significantly impact functioning for an ADHD diagnosis. The diagnostic process includes:

Clinical interviews: Gathering information from the individual, parents, teachers, and other relevant sources about the presence and severity of ADHD symptoms.

ADHD rating scales: Completion of standardised rating scales or questionnaires that assess ADHD symptoms and their impact on daily functioning.

Medical evaluation: Ruling out other medical conditions such as absence seizures in young children, for example, that may mimic ADHD symptoms.

What are the treatment options?

Research highlights the importance of extended monitoring and treatment of children with ADHD. The treatment typically involves a multimodal approach that combines medication, behavioural therapy, education, and support.

Medication: Stimulant medications, such as methylphenidate (Ritalin) and amphetamines (Adderall), are commonly prescribed to manage ADHD symptoms. They help inhibit unnecessary stimuli in order to help the person to be more functional. Non-stimulant medications like atomoxetine (Strattera) and guanfacine (Intuniv) may be used as alternatives or in combination with stimulants.

Behavioural therapy: This is important to provide the ‘exit plan’ of ADHD so that the individual eventually does not need to rely on medications. Various forms of behavioural therapy, such as cognitive-behavioural therapy (CBT) and behaviour management techniques, can help individuals with ADHD develop coping strategies, improve organisational skills, enhance time management, and strengthen social skills.

Education and support: Psychoeducation is essential to demystify the medical condition. It provides individuals and their families with information about ADHD, strategies for managing symptoms, and support in navigating challenges. Support groups and individual counselling can also offer emotional support and guidance.

In addition to medical interventions, several strategies such as family therapy can help individuals with ADHD to manage their symptoms effectively. Collaborative efforts among healthcare professionals, educators, families, and individuals with ADHD are vital in providing the necessary support and resources needed to thrive with ADHD.

(Medically reviewed by Dr Eunice Wong, First Check member and paediatrician, with special interest in treating ADHD in children and adults, Hong Kong.)