What Is ADHD and How Is It Managed?

I have met several people, including some doctors, who are skeptical about ADHD (Attention Deficit Hyperactivity Disorder) and question the sudden rise in the number of young people being diagnosed with this condition. I believe that ADHD has always been there, but previously, it was not well recognized and not actively managed.

ADHD is one of the common neurodevelopmental conditions which is being increasingly recognized in the past few decades. Family and all professionals dealing with children (teachers, family doctors, etc.) should develop awareness of this condition and know when to seek further help. Pediatricians, child psychiatrists, and relevant multidisciplinary professionals commonly manage children with ADHD in their clinical practice.

What Is ADHD?

ADHD is a condition where sufferers present with restlessness, poor attention, overactivity, and impulsivity, which are noticeable from an early age. These symptoms have to be present across different situations and should impair the person’s normal functioning to suspect ADHD.

Is ADHD a Real Condition?

Yes. Some consider ADHD as a social construct, but there is emerging evidence to show the neurobiological basis of ADHD. ADHD is highly heritable (genetic component is quite high). It is quite common for ADHD symptoms to run in families.

How Common Is ADHD?

Various studies show prevalence to be around 5 % in school going children. Global studies show a range from 2.5 % to 10 %, sometimes even higher. So it is quite common. Prevalence decreases in the adult age group.

How Can ADHD Affect One’s Life? Why Should ADHD Be Recognized and Treated?

Untreated ADHD has a profound negative impact on the child and family. ADHD patients are at a higher risk of developing behavioral problems, poor academic and occupational achievement, drug problems, and difficulty complying with the law. With properly managed, children with ADHD perform better at school, do well academically, develop better peer relationships, and respond better to their parents and teachers.

How Is ADHD Diagnosed?

There are clear diagnostic criteria (ICD-10 and DSM 5), which help us to diagnose ADHD after a thorough clinical assessment including a detailed developmental history and collaborative information from multiple sources.

In the case of children and adolescents, interviews with the child, parents, and information from school are essential to make a diagnosis.

ADHD is a clinical diagnosis. Brain scan (MRI, CT scan) and EEG are not necessary to make a diagnosis, but sometimes may be needed when history is suggestive of other conditions that mimic ADHD.

Can Other Conditions Be Mistaken for ADHD?

Not all naughty and poorly behaved children have ADHD. Neither is ADHD an excuse for poorly parented children. Children with various conditions like learning disabilities, anxiety disorder, attachment disorder, mania, and absence seizures can present with ADHD like symptoms. Also, children from a disrupted and chaotic family situation can also present with similar symptoms.

In adults with ADHD, problems with inattention are more noticeable as other symptoms are less prominent when compared to children.

How Can ADHD Be Managed?

Not all people with ADHD type symptoms will be seen by medical professionals. Mild to moderate symptoms in children can be managed effectively by behavioral intervention by parents and school. Moderate to severe ADHD may benefit from medication. American Academy of Pediatrics (AAO) put forward a systematic approach for the treatment of ADHD children. As per their criteria, the treatment strategy is largely dependent on the age of the child. For younger children below six years of age, parental training and counseling are given for tackling the child’s behavior. It is the initial therapy for ADHD patients. For children who are over the age of six, an integrated therapy encompassing both behavioral and pharmacological interventions is adopted.

Does Everyone Diagnosed with ADHD Need Medication?

No. Only moderate to severe ADHD will need medication for symptomatic control, which can be decided after assessment.

Stimulant medication (Methylphenidate, Dexamphetamine) and non-stimulant medication (Atomoxetine) are some of the options available. Other medications like Clonidine and Guanfacine are also helpful in some cases.

Is ADHD Medication Safe?

ADHD medications are well studied and if prescribed correctly will be largely beneficial to the majority of the patients. There are some contraindications and medical conditions when these medications should be used with caution. The doctor will assess each patient individually before prescribing medication. Patients will need to be followed up regularly to ensure tolerability and safety.

Will Children Grow out of ADHD?

ADHD symptoms may become less prominent in a significant proportion of adolescents when they reach early adulthood. The prefrontal cortex (part of the brain involved with executive function skills) continues to mature till a person is in their early 20s.

In some ADHD cases, symptoms may persist during adulthood, and it will help to continue medication. It is recommended that the need for continuing medication is reviewed every year.

Overall, we have to remember that ADHD is not a negative condition. In fact, I will say that if correctly identified and properly managed, young people with ADHD will have much better functional outcomes. Parents and teachers have to work together both during the diagnosis and management of children with ADHD.