Attention Deficit Hyperactivity Disorder: Types, Causes and Treatment

By Wasim Kakroo

ATTENTION Deficit Hyperactivity Disorder ADHD is a complex brain disorder that impacts how you pay attention, sit still, and control your behavior because of its impairing effect on the development of the brain’s executive functions.

ADHD is one of the most commonly diagnosed mental disorders in children with boys more likely to get diagnosed for it than girls. It’s usually identified during the early school years, when a child begins to show problems in paying attention.

It is important to mention that ADHD can’t be prevented or cured, but early identification, in addition to having a good treatment and education plan, can help a child or adult with ADHD handle their symptoms.

What are the symptoms of ADHD?

ADHD Symptoms in children:

Symptoms are grouped into three types:

Inattentive. 

A child with ADHD:

• gets easily distracted
• Doesn’t usually follow directions or finish tasks
• Seems lost somewhere
• Doesn’t pay attention and makes careless mistakes
• Forgets about daily activities
• Has problems in organizing daily tasks
• Often loses things
• Tends to daydream

Hyperactive-impulsive. 

A child with ADHD:

• Often fidgets, or bounces when sitting
• Doesn’t stay seated
• Has trouble playing quietly
• Is always moving, such as running or climbing on things.
• Talks excessively
• Is always “on the go,” as if “driven by a motor”
• Has trouble waiting for their turn
• Blurts out answers before listening to the complete question
• Butts into conversations of other people

Combined type. 

This involves signs of both types discussed above.

Symptoms in adults

Symptoms of ADHD may change as a person gets older. They include:

• Often being late or forgetting things
• Anxiety
• Low self-esteem
• Problems at work
• Trouble controlling anger
• Impulsiveness
• Substance misuse or addiction
• Trouble staying organized
• Procrastination
• Easily frustrated
• Often bored
• Trouble concentrating when reading
• Mood swings
• Depression
• Relationship problems

Causes:

Experts aren’t sure what causes ADHD. Several things may lead to it, including:

1. Genes. ADHD tends to get inherited and run in families.
2. Chemicals. People with ADHD may have an imbalance in their brain chemicals.
3. Brain changes. Children with ADHD have less activity in the areas of brain that control attention.
4. Poor nutrition, infections, smoking, drinking, and substance abuse during pregnancy can affect a baby’s brain development leasing to ADHD.
5. Toxins, such as lead may affect a child’s development of the brain.
6. Damage to the frontal lobe can cause issues in controlling impulses and emotions.

ADHD Diagnosis and Testing:

Clinical Psychologists/Psychiatrists diagnose ADHD in children and adolescents after discussing symptoms in depth with the child, parents, and teachers, and then clinically observing the child’s behaviors.

To confirm a diagnosis of ADHD or learning differences, a clinical psychologist may perform a battery of tests to check the neurological and psychological status of the child’s condition. 

The tests may include:

A medical and social history of both the child and the family.

An evaluation of intelligence, aptitude, personality traits etc. These are often done with input from the parents and teachers if the child is of school age.

ADHD Treatment

There are several approaches to treating ADHD. But research suggests that for many children, the best way to manage symptoms is a multimodal approach involving multiple methods of treatment that work together. Many symptoms of ADHD can be managed with combination of medication and therapy. Close cooperation among Clinical Psychologists, Psychiatrists, teachers, and parents is very important.

Medication. They can help control hyperactive and impulsive behavior and improve attention span.

Psychotherapy can help someone with ADHD learn better ways to handle their emotions and frustration. It can also improve their self-esteem. Counseling may also help family members better understand a child or adult with ADHD. It can help such children in developing various social skills.

Parenting tips for ADHD:

Parenting a child with ADHD isn’t like traditional childrearing as usual rulemaking and household routines can become almost impossible, depending on the type and severity of your child’s symptoms. Thus you’ll need to implement different approaches. It can become maddening to deal with some of the behaviors resulting from your child’s ADHD, but there are ways to make life easier.

By following these guidelines, you can limit destructive behavior and help your child overcome self-doubt and improve his or her self esteem and self efficacy.

1. Encourage and reward good behavior (positive reinforcement) and remove rewards by following bad behavior with appropriate consequences, leading to the extinguishing of bad behavior.
2. Define the rules, but allow some flexibility: Don’t be too strict while consistently rewarding good behaviors and discouraging destructive ones as children with ADHD may not adapt to change as well or as quickly as others. Allow them to make mistakes as they learn. Accept odd behaviors that aren’t detrimental to your child or anyone else as part of your child’s individual personality. Discouraging and rebuking your child for every odd behavior (just because you felt that they are unusual) may prove more harmful than the consequences of that odd behavior.
3. Manage aggression: Try to ignore mildly disruptive behaviors as a way for your child to release his or her pent-up energy or frustration. Always punish destructive, abusive, or intentionally disruptive behavior which goes against the rules you establish punishment certainly has its place. However, punishment should never involve physical or verbal abuse, and it should be used only as a last resort as excessive and consistent use of punishment may turn abusive.
4. Create structure: Simple daily tasks, such as having a particular meals time, study time, play time etc. can provide essential structure to the child’s daily life.
5. Break tasks into manageable pieces: Everyday tasks should be broken down into small discrete tasks. E.g., if a child has been asked to clean their room, it may be helpful to break this task into smaller tasks, by instructing him to make the bed, put any toys on the floor back into cupboard, or fold their clothes. Similarly break study time into slots. Don’t expect your child with ADHD to go for a marathon study time. Allow the child to have regular breaks after every 10 minutes during the study time.
6. Limit distractions: Since a child with ADHD gets easily distracted, creating a special, quiet space for your child to read, do homework, and take a break from the chaos of everyday life may help reduce unnecessary distractions. Things that can cause distraction and encourage impulsive behaviors such as television, mobile, video games, computer etc. should be regulated. Your child can have a better outlet for pent-up energy if you decrease their time with electronics and increase their time doing engaging activities outside the home. Outdoor activities can also help them develop better social skills if properly guided.
7. Encourage exercise: Physical activity burns excess energy in healthy ways. It also helps a child focus their attention on specific movements. This may decrease impulsivity. Exercise may also help in improving concentration, decrease the risk for depression and anxiety, and stimulate the brain in healthy ways.
8. Regulate sleep patterns: Children with ADHD may have difficulty handling themselves during the bedtime. Indiscipline in sleep schedule and lack of sleep thereof may exacerbate inattention, hyperactivity, and recklessness. To help your children get better restful sleep, eliminate stimulants like caffeine, and decrease television time especially around bedtime.
9. Keep it interesting: Complex tasks usually attract and interest children with ADHD and they are less likely to get distracted during such tasks. Such children often get distracted if a task is not challenging enough. So if a child enjoys challenging activities and can focus while doing them, it is worth encouraging them to continue.
10. Remember that all children misbehave: Don’t label every act of your child as a part of his or her ADHD. Remember that all children misbehave sometimes. Learn which behaviors need supervision, and which ones are normal parts of their childhood.
11. Accept the fact that your child — like all children — is imperfect: Try to love your child unconditionally irrespective of the mistakes he or she does on daily basis. It may help the child feel less guilty and encourage him or her to work on their issues.
12. Be kind to yourself and your partner: Be kind to yourself while helping your child. Blaming yourself or your partner for the problems your child has is not going to help.
13. Take breaks: Tending to the needs of the child with ADHD can be very draining task and can lead to building up of frustrations. So you’ll need your own breaks to ease out. Scheduling alone time is important for any parent.

    Good break options include:

    going for a walk

    going to the gym

    taking a relaxing bath

14. Calm yourself: In order to help your child with ADHD, you need to compose your behavior. Children imitate the behaviors they see around them, so if you remain calm and controlled during an anger outburst, it will help your child to do the same. Take time to breathe, relax, and be thoughtful before trying to pacify your child. The calmer you are, the calmer your child will become.

Understanding your child with ADHD and tending to their needs is an uphill task, but a team effort between Clinical psychologists, Psychiatrists, Teachers and Parents can turn the tables and facilitate the child with ADHD to live a productive and purposeful life. Let us join hands and make it happen!

Views expressed in the article are the author’s own responsibility and are not a substitute for medical advice. These are for educational purposes only. 

• The author is a Consultant Clinical Psychologist. Works as child and adolescent therapist at child guidance and wellbeing centre at INSTITUTE OF MENTAL HEALTH AND NEURO SCIENCES KASHMIR. Email address: [email protected] 

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