Attention deficit hyperactivity disorder (ADHD)

Symptoms of ADHD are most commonly observed in school-aged children. Children with ADHD often experience an ongoing pattern of the following types of symptoms:

1. Inattention
   It includes symptoms that develop due to a lack of focus and organization.
2. Hyperactivity
   Children with ADHD are hyperactive, i.e., in constant movement even when it is not appropriate.
3. Impulsivity
   Children with ADHD show impulsive behavior, which includes taking action without thinking. They have a hidden desire for immediate rewards.

Some common signs and symptoms of all these three behaviors are:

• Having difficulty sustaining attention during play or tasks, such as conversations, lectures, or lengthy reading
• Taking unnecessary risks
• Having a hard time resisting temptation
• Having trouble taking turns
• Having difficulty getting along with others
• Finding it hard to follow through on instructions
• Having difficulty organizing tasks and activities
• Avoiding tasks that require sustained mental effort
• Daydreaming
• Forgetting things
• Squirming
• Excessive talking
• Making careless mistakes

Interestingly, boys and girls are much more likely to express a different set of symptoms.

Symptoms in boys
The externalized symptoms commonly associated with ADHD behavior are more widely seen in boys. Due to this, boys have a much higher chance of being diagnosed with ADHD. The set of symptoms includes:

• Impulsivity or acting out
• Running
• Hitting
• Lack of focus
• Physical aggression

Symptoms in girls
Most of the girls with ADHD may remain unidentified. This is due to the differences in the expression of the disorder among boys and girls. Females with ADHD are reported to have fewer hyperactive/impulsive symptoms and more inattentive symptoms when compared with males with ADHD. These symptoms aren't as apparent as they are in boys and include:

• Being withdrawn
• Low self-esteem
• Anxiety
• Intellectual impairment
• Difficulty with academic achievement
• Tendency to daydream
• Verbal aggression (teasing, taunting, or name-calling)

Quick byte!
Although not exclusively specific to ADHD, many children with this condition can also experience insomnia (trouble falling and staying asleep). In addition to insomnia, kids with ADHD can also struggle with low sleep quality, daytime drowsiness, and sleep apnea (a sleep disorder in which breathing repeatedly stops and starts during sleep).

Symptoms in adults
Although ADHD is considered a disease of childhood, it is estimated that 2%-6% of adults also have ADHD. Around two-thirds of children with ADHD retain their symptoms even when they grow up. Adults with ADHD usually demonstrate hyperactive symptoms, such as feeling internally restless and fidgety. They also often find it difficult to:

• Manage their attention
• Complete lengthy tasks unless interesting
• Stay organized
• Control their behavior

The exact cause of ADHD is not known. However, the role of certain brain regions has recently been established in ADHD. These regions are smaller and less active in individuals with ADHD. The altered function of these regions may be responsible for various associated symptoms, as they perform tasks such as:

• Coordinating sensory input with emotions
• Regulating aggressive behavior
• Facilitating communication
• Expressing emotions
• Making decisions
• Planning

These changes can be triggered by various risk factors discussed in the next section.

ADHD can be influenced by personal, familial, and social factors similar to other mental conditions. The associated risk factors are:

1. Age
   Children between the ages of 3 and 12 years are more prone to ADHD. In India, about 7% of school-going children are diagnosed with ADHD.
2. Family history
   Siblings of children with ADHD are at increased risk of the disorder. Family studies have identified a 2- to 8-fold increase in the risk for ADHD in parents and siblings of children with ADHD. Twins are also more likely to have ADHD than singletons.
3. Factors affecting expectant mothers
   Children born to women exposed to the following contaminants/drugs are more prone to ADHD:
   • Lead
   • Cigarette smoke
   • Alcohol
   • Medications such as corticosteroids and antidepressants
   • Certain food additives
   Additionally, the following conditions in the expectant mother might increase the chance of ADHD in their child:
   • Stress
   • Mental conditions
   • High blood pressure
   • Hyperthyroidism
   Get your thyroid levels checked.
4. Premature delivery
   Babies born a few weeks early (before 37 weeks) are at increased risk of developing ADHD in later life.
5. Low birth weight
   Studies suggest that children with lower weight at the time of birth have a higher chance of developing ADHD in later life. This can be attributed to compromised development of the nervous system.
6. Neonatal diseases
   Children born with the following conditions are more susceptible to developing ADHD:
   • Hypoglycemia
   • Kidney conditions
   • Liver conditions
   • Human immunodeficiency infection
7. Medical conditions
   Individuals with certain medical conditions are more prone to ADHD. Such conditions include:
   • Seizures
   • Asthma
   • Gastrointestinal disorders such as celiac disease and gluten sensitivity

The diagnosis of ADHD is made through:

1. Ruling out other conditions

ADHD exhibits a similar set of symptoms to various other learning disabilities and mental disorders, such as:

• Depression
• Bipolar disorder
• Anxiety
• Obsessive-compulsive disorder

Therefore, it is essential to rule out these medical conditions through laboratory and imaging tests, such as X-rays or brain scans. Sometimes, the symptoms can be a side effect of various medications, usually checked through blood tests.

2. Clinical examination

ADHD is diagnosed through symptoms and does not have any specific tests. Healthcare providers rely on the crucial guidelines outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5), to ensure a standardized and accurate diagnosis of ADHD. DSM-5 provides a list of inattentive and hyperactivity/impulsivity symptoms.

ADHD is confirmed by the presence of at least 6 symptoms for children up to age 16 years. Individuals above 17 years of age should present with at least 5 symptoms to be diagnosed with ADHD. Symptoms should be present in multiple settings, such as at school, work, or home, and should cause significant impairment in social, occupational, and academic functioning.

Quick byte! Younger kids in the same class are more likely to be wrongly diagnosed with ADHD because a few months can affect their ability to focus and behave.

List of symptoms as per DSM-5

• Inattention
• Making careless mistakes
• Failure to give close attention
• Failure to listen when spoken directly
• Not able to follow instructions
• Trouble organizing tasks
• Avoids tasks that require mental effort
• Often loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
• Easily distracted
• Forgets even basic things

• Hyperactivity/impulsivity
• Keeps moving the body
• Leaving seat in situations when remaining seated is expected
• Runs about or climbs in inappropriate situations
• Unable to play or take part in leisure activities quietly
• Always “on the go,” acting as if “driven by a motor”
• Talking excessively
• Blurting out an answer before a question has been completed
• Trouble waiting their turn
• Interrupting others

Note: These symptoms are presented for informational purposes only. Only a trained healthcare provider can diagnose or treat ADHD.

ADHD cannot be prevented. However, the risk can be attenuated through the following ways:

1. Take caution during pregnancy
   The exposure to certain contaminants and drugs during pregnancy increases the risk of ADHD in the developing child. Pregnant women should avoid:
   • Smoking
   • Alcohol
   • Exposure to contaminants such as lead and polychlorinated biphenyls (PCBs)
   • The use of certain medications, such as corticosteroids and antihypertensives, which are associated with an increased risk of ADHD in children. It is advisable to consult with your doctor before taking any medications during pregnancy.
2. Protect your child from toxins
   Children should be protected from exposure to pollutants and toxins, as this increases the likelihood of developing ADHD. Specific toxins to avoid include:
   • Cigarette smoke
   • Agricultural or industrial chemicals
   • Lead paint (found in some old buildings)
3. Limit screen time
   While not proven, it may be wise for kids to limit TV and video game time during the first five years.

In addition to these measures, the following strategies may help reduce complications in children with ADHD:

• Establish a routine for daily activities such as wake-up time, meal times, reading, and playing.
• Give full attention to your child while providing instructions.
• Maintain communication with your child’s teachers and caregivers to gain a comprehensive understanding of their overall behavior.

The lives of people living with ADHD can be drastically improved through accurate diagnosis and effective treatment. The type of treatment depends upon the age of the patient. The various treatment options include:

A. Behavioral therapy
Behavior management is the first line of treatment for children younger than six years of age. The recommendations for children aged six and older involve combining medication and behavior therapy. Behavior therapy aims to strengthen positive behaviors and eliminate unwanted or problematic behaviors. It is often helpful to start behavior therapy as soon as a diagnosis is made. It includes:

• Parent training
• Behavior therapy with children
• Behavioral interventions in the classroom
• Peer interventions
• Organizational skill training

B. Medications
Medications are also used to control ADHD symptoms in daily life. It includes:

1. Stimulants: They are the mainstay drug category used in ADHD. Common examples include amphetamines and methylphenidates.
2. Nonstimulants: Children who cannot tolerate stimulants or have anxiety are usually prescribed nonstimulants. It includes:
• Antidepressants (Atomoxetine, Bupropion)
• Alpha agonists (Clonidine, Guanfacine)

Quick Byte!
A technique called a trigeminal nerve stimulation system has shown promise for managing ADHD. The device delivers mild stimulation to trigeminal nerve branches, suppressing hyperactivity.

Here are a few important points that people with ADHD should follow:

A. Make dietary alterations

While diet is not directly associated with decreasing the symptoms of ADHD, eating a balanced diet of fresh and wholesome food helps maintain overall health.

Here is a list of foods that people with ADHD can add to their diet:

• Apple: People with ADHD should increase their intake of complex carbohydrates. Apples are a rich source of complex carbohydrates. Pears can also be used as an alternative. Eating these types of foods just before bedtime may help people with ADHD sleep better.
• Fatty fish: Omega-3 fatty acids have been known to significantly decrease ADHD symptoms in children and adults. Cold-water fatty fish, such as salmon, mackerel, tuna, herring, and sardines, are excellent sources of Omega-3 fatty acids. They can be used to make wraps, sandwiches, pasta, and salads. One can also augment the diet with Omega and fish oil supplements.
• Nuts: Walnuts, almonds, and cashews are rich sources of omega-3 fatty acids, vitamins, and minerals.
• Leafy Greens: People with ADHD should include green leafy vegetables like spinach in their diet. Spinach can be cooked or blended with berries or fruit into a smoothie.
• Orange: Oranges help people with ADHD symptoms sleep well. They can be consumed in a fruit salad or as orange juice. Rich in vitamin C, oranges are an excellent addition to your fruit bowl.

Quick Byte! Foods rich in proteins such as poultry, fish, eggs, beans, nuts, soy, and low-fat dairy products can benefit people with ADHD symptoms. A protein-rich diet helps release chemicals that mediate communication between brain cells and prevents spikes in blood sugar levels that increase hyperactivity.

Avoid certain foods

Studies indicate that additives like sodium benzoate, food colorings, and preservatives could potentially worsen symptoms of ADHD. Foods with these colorings and preservatives should be limited or avoided. Such foods include:

• Carbonated beverages
• Salad dressings
• Fruit juice products
• Breadcrumbs
• Candies
• Icing
• Soft drinks
• Pickles
• Ice creams

B. Exercise regularly

Regular exercise has been shown to reduce symptoms of ADHD. The following forms of exercise can be done:

• Running
• Walking briskly
• Biking
• Swimming laps
• Dance
• Gymnastics
• Yoga
• Strength training
• Squats
• Pushups
• Pullups
• Weightlifting

Remember, your health is our priority. Before embarking on any exercise program, it's crucial to have a conversation with your doctor. They can guide you on how much you can handle, taking into account your age and health condition.

C. Maintain a sleep schedule

People with ADHD may suffer from sleep problems. Here are a few tips that might help them get a good night's sleep:

• Stick to a proper sleep schedule to regulate the body's internal clock.
• Minimize screen time before bedtime.
• Avoid the intake of caffeine, like tea or coffee, especially in the late evening and night.
• Opt for a balanced light dinner to avoid indigestion and discomfort that hamper the sleep cycle.
• Engage in regular physical activities. However, try to wind up your workout session at least 2 hours before bedtime.

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• Academic issues and failure
• Accidents due to impulsive behavior and constant need for movement
• Low self-esteem
• Alcohol and drug abuse
• Learning disabilities
• Depression
• Anxiety
• Oppositional defiant disorder (a mental disorder characterized by frequent anger)
• Mania
• Tourette syndrome (sudden twitches, movements, or sounds that people do repeatedly)

The following therapies can support the conventional treatment and help improve the symptoms of ADHD:

1. Calming Techniques

Calming techniques help subside various symptoms by improving overall mental well-being. The various calming techniques that can be adopted include:

• Mindfulness meditation
• Breathing exercises
• Journaling for mental health
• Yoga or Tai Chi

Daily medication and daily yoga practice have positive effects on anxiety, hyperactivity, and social issues.

Here are 5 easy yoga poses for beginners.

2. Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a talking therapy that helps manage problems by changing one's thinking. It allows individuals to cope better with the factors that trigger symptoms of ADHD and improves a sense of control over behavior.

3. Self Massage

Rubbing the neck, scalp, and skin behind the ear is an effective relaxation method. It makes an individual feel pampered and reduces negative thoughts. Practicing this after a stressful day is associated with fewer symptoms of ADHD.

4. Family and Marital Therapy

This therapy provides guidance on managing disruptive behaviors within families and relationships. It encourages behavior changes and improves interactions with individuals with ADHD.

5. Parenting Skills Training

This involves skill training for parents to encourage and reward positive behaviors in their children. Parents are educated on using a system of rewards and consequences to alter a child's behavior.

Living with attention deficit hyperactivity disorder (ADHD) can be challenging, as the symptoms can complicate daily tasks. It can make everyday activities exhausting and stressful. Getting the required support to comprehend and handle your child's condition is vital. The following measures help make life easier and improve overall quality of life.

• Keep yourself educated: People with ADHD and parents of children with ADHD should educate themselves about the condition.
• Stay in touch with the healthcare provider: Patients and parents need to stay in constant touch with their healthcare providers. Open communication between the two is essential, as it helps to trace progress. Regular follow-up is also essential to check the symptoms and associated comorbidities such as depression. Ongoing interaction between the primary caregiver and the family is crucial for optimizing the medication treatment.
• Avoid potential allergens: Possible allergens can trigger ADHD symptoms in some cases. Diets that restrict possible allergens may help improve behavior in ADHD.
• Spend time outside: Spending time outside has been associated with a positive effect on behavior. Dedicate some time to walking outdoors, especially in greenery. Studies have shown that spending even 20 minutes outdoors can have a positive impact on overall health status.

Tips for parents: The following tips can assist parents in effectively managing their children with ADHD and improving their overall performance.

• Give medicines on time and keep them out of reach of children.
• Discuss ADHD openly and supportively with your child.
• Stay updated about ADHD symptoms and treatment. You can do this by joining online platforms, staying in touch with the doctor, and joining support groups.
• Focus on your child's strengths and positive qualities.
• Encourage the child to keep their things (school bags, clothes, and toys) organized.
• Limit screen time.
• Break down complicated tasks into simpler and shorter steps.
• Use goals and praise or other rewards to keep the child motivated.
• Manage discipline by giving directions politely instead of scolding, yelling, or spanking.
• Provide a healthy lifestyle to the child by giving them nutritious food, keeping them engaged in physical activity, and ensuring sufficient sleep.

Addressing workplace issues in adults: Adults also need better communication skills, distractibility, procrastination, and difficulty managing complex projects. The following measures might help in solving these problems:

• Try to minimize distractibility by using "white noise" earphones, working in unused spaces, jotting down ideas in a notebook, keeping a list of ideas, and performing one task at a time.
• Temper outbursts can be effectively managed through self-talk to monitor impulsive actions, working with a coach, asking for regular, constructive feedback, and practicing relaxation and meditation techniques.
• Take intermittent breaks, take notes in meetings, move around, exercise, take a walk, or run up and down the stairs between work.