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Unlocking the Mysteries of ADHD; a Neurodevelopment Disorder.


Brain cells

ADHD stands for Attention-Deficit Hyperactivity Disorder, which is a prevalent neurodevelopment disorder. It is typically first diagnosed in childhood and often lasts into adulthood, and yes, individuals don’t grow out of ADHD. Individuals who seem to grow out of it learned to compensate so well that they appear not to have it.


ADHD is characterised by ongoing and significant challenges in three main areas: Inattention, Hyperactivity, and Impulsivity.



1. Inattention

Individuals with ADHD may have difficulty sustaining attention on tasks or activities, struggle to follow through on instructions, and often appear forgetful or disorganized. Some of the common struggles are:

  • Often forgetful in daily activities.

  • Often fails to give close attention to details.

  • Often easily distracted by extraneous stimuli.

  • Often has difficulty organising tasks and activities.

  • Often does not seem to listen when spoken to directly.

  • Makes careless mistakes in schoolwork or other activities.

  • Often has difficulty sustaining attention in tasks or play activities.

  • Often does not follow instructions and fails to finish schoolwork, chores, or duties.

  • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort.

  • Often loses things necessary for tasks or activities (toys, school assignments, pencils, or books)


2. Hyperactivity

Hyperactive

This symptom involves excessive motor activity, such as fidgeting, tapping, or restlessness. Children may find it challenging to sit still or engage in quiet activities. Some of the common struggles are:

  • Impatience in waiting.

  • Constant movement & talking.

  • Often fidgets or squirms in the seat.

  • Often ‘on the go or often acts as if he is ‘driven by a motor’.

  • Often has difficulty playing or engaging in leisure activities quietly.

  • Often runs about or climbs excessively in situations where it is inappropriate. (classroom, mealtime, meeting, etc.)

Hyperactivity doesn’t always happen physically; it could happen mentally as well. The mind of someone with ADHD is consistently active, but it struggles to focus on one thing. Think of it as having a webpage with 30 to 40 other tabs open and running simultaneously.


3. Impulsivity

Individuals with ADHD may act without thinking about the consequences, interrupt others, and have difficulty waiting their turn in conversations or activities. Some of the common struggles are:

  • Often talks excessively.

  • Letting out inappropriate comments.

  • Often interrupts or intrudes on others.

  • Often blurts out answers before questions have been completed.

 

🔎 The ADHD Brain

ADHD

ADHD is closely associated with the prefrontal cortex, a crucial brain area responsible for executive functions. Executive functions refer to a set of cognitive processes that allow individuals to plan, organise, prioritise, initiate, and control their actions to achieve goals and adapt to new situations.


Research has shown that individuals with ADHD (neurodivergent) often exhibit differences in the structure and function of their prefrontal cortex compared to neurotypical individuals. These differences are believed to contribute to the characteristic symptoms of ADHD, such as inattention, hyperactivity, and impulsivity.


The prefrontal cortex is associated with ADHD in the following ways:

  • Reduced Volume: Studies using brain imaging techniques, such as MRI (magnetic resonance imaging), have revealed that individuals with ADHD tend to have slightly smaller volumes in certain regions of the prefrontal cortex compared to neurotypical individuals. This reduction in volume is particularly evident in the dorsolateral prefrontal cortex, which is associated with working memory and cognitive control.


  • Altered Connectivity: The prefrontal cortex communicates with other brain regions through neural networks. Research suggests that the connectivity between the prefrontal cortex and other brain areas involved in attention and impulse control may be disrupted in individuals with ADHD, leading to difficulties in regulating behaviour.


  • Dopamine Dysfunction: The prefrontal cortex relies on the neurotransmitter dopamine to function effectively. People with ADHD often have dysregulation of dopamine, which can impact the proper functioning of the prefrontal cortex’s executive functions. Dopamine plays a crucial role in motivation, reward processing, and attention.

These neurological differences in the prefrontal cortex contribute to the challenges experienced by individuals with ADHD in various aspects of their lives. For example, difficulties in working memory may make it hard to retain and manipulate information, leading to forgetfulness and disorganisation. Impaired cognitive control can result in impulsivity and a reduced ability to inhibit impulsive responses.


 
ADHD is a complex neurodevelopment disorder with varying degrees of severity and can manifest differently in different individuals. It is essential to note that not all individuals with ADHD exhibit hyperactivity; some may primarily experience symptoms related to inattention.

Diagnosing ADHD involves a comprehensive evaluation by healthcare professionals, considering the individual’s medical history, behaviour patterns, and the presence of symptoms in different settings (e.g., home, school, work). It is crucial to rule out other medical or psychological conditions that might mimic ADHD symptoms.
 


🔎 Comorbidity with ADHD

ADHD often coexists with other medical or psychological conditions, known as comorbidity. It is common for individuals with ADHD to experience one or more additional conditions simultaneously, which can complicate diagnosis, treatment, and overall management. Some of the most common comorbidities associated with ADHD include:

  • Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD): Children and adolescents with ADHD may also exhibit oppositional and defiant behaviours characterized by frequent arguments, defiance, and hostility toward authority figures. In more severe cases, these behaviours can escalate to conduct disorder, involving aggressive, antisocial, or rule-breaking conduct.


  • Anxiety Disorders: Anxiety disorders, such as generalized anxiety disorder, social anxiety disorder, or separation anxiety disorder, often co-occur with ADHD. The challenges of managing ADHD symptoms can contribute to feelings of worry, fear, and unease.


  • Mood Disorders: Conditions like depression and bipolar disorder can be comorbid with ADHD, especially in adolescents and adults. Emotional dysregulation and difficulty coping with life’s challenges may contribute to mood disturbances.


  • Learning Disabilities: Learning disabilities, such as dyslexia or dyscalculia, may overlap with ADHD, as both can affect academic performance and attention differently.


  • Autism Spectrum Disorder (ASD): Some individuals with ADHD may also exhibit features of autism spectrum disorder, such as difficulties in social communication and restricted or repetitive behaviours.


  • Sensory Processing Disorders: Sensory processing difficulties, where individuals have atypical responses to sensory stimuli (e.g., sound, touch, light), can occur alongside ADHD.


  • Sleep Disorders: ADHD can disrupt sleep patterns, leading to sleep difficulties such as insomnia or restless sleep. In turn, sleep disturbances can exacerbate ADHD symptoms.


  • Substance Use Disorders: Adolescents and adults with ADHD may be at a higher risk of developing substance use disorders, as they may turn to substances to cope with their challenges.

 


🔎 Intervention/Support for ADHD

A person with ADHD has the power of a Ferrari engine but with bicycle-strength brakes. The mismatch between the engine’s power and the brakes’ capability poses various challenges. The key lies in enhancing one’s braking system (intervention) to overcome these challenges effectively.

Interventions for ADHD aim to address and support the specific challenges and symptoms associated with the condition. These interventions can be broadly categorized into non-pharmacological (behavioural) and pharmacological (medication) interventions. A comprehensive and multimodal approach often yields the best results. Here are some common interventions for ADHD:


Behavioural Therapy: Behavioral interventions are fundamental in managing ADHD symptoms. These therapies teach individuals coping skills, improve self-regulation, and foster positive behaviours. Behavioural treatment may involve:

  • Parent Training: Educating parents and caregivers on effective parenting techniques and behaviour management strategies to support the child’s behaviour at home.


  • Cognitive-Behavioural Therapy (CBT): CBT helps individuals identify negative thought patterns and develop strategies to manage emotions and impulsive behaviours.


  • Social Skills Training: Teaching children and adolescents with ADHD appropriate social skills to enhance peer interactions and develop meaningful relationships.

Time Management and Organizational Strategies: Organizational skills and time management techniques can help individuals with ADHD stay on top of tasks and responsibilities. This includes using planners, setting reminders, and breaking larger tasks into manageable steps.


Exercise and Physical Activity: Regular physical activity can help reduce hyperactivity and improve overall mood and attention.

Mindfulness and Relaxation Techniques: Teaching relaxation techniques, such as deep breathing or mindfulness exercises, can help individuals manage stress and regulate emotions.


Coaching and Support Groups: Coaching or participating in support groups with others who have ADHD can provide emotional support, encouragement, and practical tips for coping with the challenges of ADHD.


For individuals residing in Singapore, I would like to kindly encourage you to explore UnlockingADHD for a comprehensive resource on ADHD. It could be a valuable source of information and support for individuals seeking to understand and address ADHD-related concerns.


Medication: Medicine changes the brain chemistry so that the brain may function more orderly. Medication may be recommended for individuals with moderate to severe ADHD symptoms significantly impacting daily functioning. Medications can help improve attention, impulse control, and hyperactivity. The decision to use medication should be made in consultation with a qualified healthcare professional, considering the individual’s needs and medical history.

 
ADHD can be a uniquely powerful asset, a gift if managed with understanding. The operative phrase here, of course, is “with understanding”. Depending on whether one understands ADHD, we can feel bad or good about how having it makes us think and act differently from others. --- Dr Hallowell.
 

References

American Psychiatric Association, American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association.


Hallowell, E. M., & Ratey, J. J. (2021). ADHD 2.0: New science and essential strategies for thriving with distraction — from childhood through adulthood. Ballantine Books.

 

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