Al Soor Specialist Clinic

What is Attention Deficit Hyperactivity Disorder (ADHD)?

  • Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that significantly impair functioning across multiple domains of life.
  • Despite its prevalence and impact, ADHD is often misunderstood or overlooked, leading to challenges in diagnosis and management.

Symptoms of ADHD:

  1. Inattention:

Inattentive symptoms of ADHD include:

  • Difficulty sustaining attention in tasks or play activities
  • Frequently making careless mistakes
  • Difficulty organizing tasks and activities
  • Avoidance of tasks requiring sustained mental effort
  • Often losing things necessary for tasks
  • Being easily distracted by extraneous stimuli
  • Forgetfulness in daily activities
  1. Hyperactivity:

Hyperactive symptoms of ADHD include:

  • Fidgeting with hands or feet or squirming in seat
  • Difficulty remaining seated in situations where it is expected
  • Excessive running or climbing in inappropriate situations
  • Difficulty engaging in activities quietly
  • Often “on the go” or acts as if “driven by a motor”
  • Talking excessively
  1. Impulsivity:

Impulsive symptoms of ADHD include:

  • Blurting out answers before questions have been completed
  • Difficulty awaiting turn
  • Interrupting or intruding on others’ conversations or activities
  • Impulsively starting tasks without adequate preparation
  • Difficulty in delaying responses in conversations or games

Diagnosis of ADHD:

  1. Clinical Evaluation:
  • Diagnosis of ADHD typically involves a comprehensive clinical evaluation by a qualified healthcare professional, such as a psychiatrist, or a psychologist.
  • The evaluation process includes gathering information from multiple sources, including the individual’s –
    • medical history
    • developmental milestones
    • behavioural observations
    • reports from parents, teachers, or other caregivers.
  1. Diagnostic Criteria:
  • The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides standardized criteria for diagnosing ADHD.
  • According to the DSM-5, ADHD can be diagnosed if an individual exhibits:
    • six or more symptoms of inattention and/or hyperactivity-impulsivity for children up to age 16 (five or more for adolescents 17 and older and adults)
    • symptoms which have persisted for at least six months
    • symptoms to a degree that are inconsistent with developmental level, and,
    • negatively impacts social, academic, or occupational functioning.
  1. Subtypes of ADHD:

The DSM-5 recognizes three subtypes of ADHD:

  • Predominantly Inattentive Presentation: Characterized by predominantly inattentive symptoms without significant hyperactive-impulsive symptoms.
  • Predominantly Hyperactive-Impulsive Presentation: Characterized by predominantly hyperactive-impulsive symptoms without significant inattentive symptoms.
  • Combined Presentation: Characterized by a combination of inattentive and hyperactive-impulsive symptoms.
  1. Differential Diagnosis:

It is essential to differentiate ADHD from other conditions that may present with similar symptoms, such as:

  • Learning disabilities
  • Mood disorders (e.g., depression, bipolar disorder)
  • Anxiety disorders
  • Autism spectrum disorder
  • Substance use disorders
  • Sleep disorders
  1. Assessment Tools:

Various assessment tools are available to aid in the diagnosis and evaluation of ADHD, including:

  • Behaviour rating scales (e.g., ADHD Rating Scale, Conners’ Rating Scales)
  • Continuous performance tests (e.g., Conners Continuous Performance Test)
  • Neuropsychological assessments
  • Structured interviews (e.g., Diagnostic Interview for ADHD in Adults)

Clinical Considerations:

  1. Developmental Context:
  • ADHD symptoms may manifest differently depending on developmental stage and context.
  • For example, hyperactive-impulsive symptoms may be more noticeable in younger children, while inattention symptoms may become more prominent as individuals enter adolescence and adulthood.
  1. Comorbidity:

ADHD often coexists with other psychiatric disorders, such as:

  • Oppositional defiant disorder (ODD) or Conduct Disorder (CD)
  • Anxiety Disorders
  • Depression
  • Substance Use Disorders
  • Learning Disabilities
  1. Cultural and Contextual Factors:
  • Cultural beliefs, values, and social norms may influence the expression and perception of ADHD symptoms.
  • Clinicians should consider cultural and contextual factors when evaluating ADHD and adapt assessment methods and interventions accordingly to ensure cultural competence and sensitivity.
  1. Family and Environmental Factors:
  • Family dynamics, parenting practices, socioeconomic status, and environmental stressors can impact the presentation and management of ADHD.
  • Collaborating with families and addressing environmental factors is integral to comprehensive ADHD care and treatment.
  1. Multimodal Treatment Approach:

Treatment for ADHD often involves a multimodal approach that may include:

  • Pharmacotherapy
  • Behavioural interventions (e.g., parent training, cognitive-behavioural therapy)
  • Educational accommodations (e.g., individualized education plans, classroom modifications)
  • Supportive services (e.g., peer support groups, social skills training).
  • Treatment plans should be tailored to the individual’s unique needs, preferences, and circumstances.

Conclusion:

  • ADHD is a complex neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity that significantly impact functioning across various life domains.
  • Diagnosis of ADHD involves a thorough clinical evaluation, consideration of diagnostic criteria, assessment of developmental and contextual factors, and differential diagnosis of comorbid conditions.
  • Clinical considerations include recognizing developmental context, assessing for comorbidity, addressing cultural and environmental factors, and implementing a multimodal treatment approach.
  • By understanding the symptoms and diagnostic process of ADHD and considering clinical nuances, healthcare professionals can provide comprehensive care and support to individuals with ADHD across the lifespan.