Attention Deficit Hyperactivity Disorder

What is Attention Deficit Hyperactivity Disorder?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that affects a person's ability to focus, regulate activity levels, and control impulses. It is commonly diagnosed in children but will often persist into adulthood. 


Attention Deficit Hyperactivity Disorder: Neuroanatomy and Health

ADHD is a Neurodevelopmental condition, associated with differences in attention, impulse control, and executive functioning areas of the brain. The following brain regions are implicated in ADHD:

  • Prefrontal Cortex – This region controls decision-making, impulse regulation, and focus. In people with ADHD, it often functions less efficiently, leading to difficulties with planning and organisation.
  • Basal Ganglia – Plays a role in processing information and coordinating movement. Dysfunction in this area can contribute to impulsivity and hyperactivity.
  • Limbic System – Regulates emotions and motivation. ADHD individuals may experience mood swings, frustration, or difficulty managing stress.
  • Reticular Activating System – A network that helps regulate alertness. Dysregulation can cause fluctuations between being overly energetic and struggling with fatigue.


Beyond brain function, ADHD can also have broader health implications:

  • Increased Risk of Accidents – Impulsivity can lead to higher accident rates, including traffic incidents and injuries.
  • Mental Health Issues – Anxiety, depression, and low self-esteem are common co-existing conditions.
  • Sleep Disturbances – Many individuals with ADHD struggle with insomnia or poor sleep quality, which can further impact concentration and mood.
  • Physical Health - Typically people with ADHD have higher stress and are often at risk for reduced health-promoting behaviours.


Cause and Risk Factors for Attention Deficit Hyperactivity Disorder

The exact cause of ADHD is not fully understood, but it is believed to result from a combination of genetic, neurological, and environmental influences.


Neurological Factors

  • Brain Structure and Function – Studies show that individuals with ADHD have differences in brain activity, particularly in areas responsible for impulse control, attention, and executive function.
  • Neurotransmitter Imbalance – Dopamine and norepinephrine, chemicals involved in attention and motivation, function differently in those with ADHD.


Genetic Factors

  • Family History – ADHD often runs in families, indicating a strong genetic component.
  • Specific Gene Variants – Research suggests that variations in certain genes related to dopamine regulation may contribute to ADHD.


Environmental Factors

  • Prenatal Exposure – Maternal smoking, alcohol use, and drug exposure during pregnancy can interfere with fetal brain development: though of course these factors are not always present.
  • Toxins and Diet – Exposure to heavy metals like lead and certain food additives may affect symptom severity.


Symptoms of Attention Deficit Hyperactivity Disorder

Inattentive Symptoms

  • Difficulty maintaining focus on tasks or conversations.
  • Frequently making careless mistakes in schoolwork or work-related tasks.
  • Struggling with organisation and time management.
  • Avoiding tasks that require prolonged mental effort.
  • Often losing essential items like keys, books, or school supplies.
  • Becoming easily distracted by external stimuli or unrelated thoughts.
  • Forgetfulness in daily activities, such as missing appointments or deadlines.


Hyperactive-Impulsive Symptoms

  • Constant fidgeting, tapping, or moving when expected to stay seated.
  • Difficulty engaging in quiet activities.
  • Excessive talking or interrupting conversations.
  • Acting without thinking leads to impulsive decisions.
  • Struggling to wait for turns in games or discussions.
  • Frequent risk-taking behaviour without considering consequences.


Diagnosis of Attention Deficit Hyperactivity Disorder

ADHD is diagnosed based on clinical evaluations rather than a single test. The process involves multiple steps to ensure an accurate diagnosis.

1. Medical and Family History

A doctor or psychologist will ask about:

  • Symptoms and their impact on daily life.
  • Family history of ADHD or other mental health conditions.
  • Any past medical conditions that could affect behaviour.


2. Diagnostic Criteria (DSM-5)

A diagnosis is typically based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To be diagnosed with ADHD:

  • Symptoms must be present for at least six months.
  • Symptoms must be observed in multiple settings (e.g., school, work, home).
  • The symptoms must significantly impair daily functioning.
  • The symptoms must have appeared before age 12.
  • Sometimes doctors use the terms ‘predominantly inattentive presentation’ (sometimes called ADD) for those with mainly inattentive symptoms, ‘predominantly hyperactive presentation’ for those with mainly hyperactive-impulsive symptoms, or ‘combined presentation’ for those with high levels of both symptom types.


3. Behavior and Psychological Assessments

  • Standardised ADHD rating scales and questionnaires (e.g., Vanderbilt ADHD Diagnostic Rating Scale, Conners' Rating Scales, Barkley Symptom Scales).
  • Interviews with parents, teachers, or caregivers to assess symptom patterns.
  • Cognitive and executive functioning tests may be used to rule out other conditions, and to look out for co-occurring cognitive or academic difficulties.


4. Ruling Out Other Conditions (Differential Diagnoses)

It is important to ensure that the ADHD symptoms are ‘not just due to’ the symptoms of other conditions such as:

  • Anxiety or depression.
  • Learning disabilities.
  • Sleep disorders.
  • Sensory processing issues.
  • Autism spectrum disorder.


Ruling out the above conditions as the main cause would allow these other conditions to be treated, and then perhaps the ADHD symptoms wouldn’t need treating. However, the confusing thing is that these conditions can also occur with ADHD - this is when they are called ‘comorbidities’. 


The difference is whether or not the ADHD symptoms occur only when the person is anxious, attempting a reading task, tired from lack of sleep, overwhelmed etc: in this case the person probably wouldn’t get an ADHD diagnosis. However, for some people the ADHD symptoms are present most of the time, and they just happen to have sleep difficulties or anxiety or learning difficulties as well.


Treatment of Attention Deficit Hyperactivity Disorder

ADHD treatment is tailored to each individual and often involves a combination of therapies. The goal is to improve focus, impulse control, and overall functioning.

1. Behavioural Therapy

  • Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT): Helps individuals develop coping strategies to manage impulsivity and inattention, as well as any other comorbidities such as anxiety or low mood.
  • Parent Training Programs: Educates parents on managing ADHD-related behaviors in children.
  • Social Skills Training: Helps improve communication and relationships.


2. Lifestyle and Dietary Changes

  • Regular Exercise: Physical activity helps improve focus and impulse control.
  • Healthy Diet: Reducing processed foods and increasing omega-3 fatty acids may help some individuals, as well as avoiding foods such as those high in additives which can worsen symptoms in some cases.
  • Adequate Sleep: Establishing a consistent sleep routine improves concentration and emotional regulation.
  • Plenty of Social Activity and Hobbies: Boosting mood and healthy self-esteem can help optimise functioning in people with ADHD


3. Educational and Workplace Accommodations

  • Individualised Education Plan (IEP) for students.
  • Flexible work environments and structured schedules for adults with ADHD.


4. Medication

  • Stimulants (Most Common): These include methylphenidate (Ritalin, Concerta) and amphetamine-based medications (Dexamphetamine, Vyvanse), which increase dopamine and norepinephrine levels in the brain.
  • Non-Stimulants: These include atomoxetine (Strattera) and some antidepressants, which may be used when stimulants are ineffective or cause side effects.


What if Attention Deficit Hyperactivity Disorder is Untreated?

Leaving ADHD untreated for extended periods of time can lead to significant challenges in multiple areas of life.

  • Academic and Career Struggles
  • Emotional and Mental Health Issues, Reduced Self-Esteem
  • Relationship and Social Difficulties
  • Risk-Taking Behaviors
  • Chronic Stress and Burnout
  • Physical Health Impacts


Untreated ADHD can create lifelong challenges, but early intervention and consistent management strategies can help individuals lead fulfilling and successful lives.