What is ADHD?

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurobiologic condition that is characterized by a developmentally inappropriate level of inattention [concentration, distractibility, hyperactivity, and impulsiveness that can occur in various combinations across school, home, and social settings.

‘Neurobiologic’ means that the condition is an inborn trait that cannot be avoided, like having curly hair or having a tendency to develop diabetes. This does not mean, however, that the person is abnormal, just as a person who needs glasses or medicine for diabetes should not be considered abnormal.

ADHD is estimated to occur in about 5% of the general population, which means one out of every 20 individuals may possibly have it. It is more common in boys and can be described to have three subtypes, namely: Hyperactive-Impulsive type, Inattentive type and Combined type.

HOW DOES ONE KNOW IF ONE HAS ADHD?
Only an experienced clinician can really say if one has ADHD. Below is a list of symptoms that may suggest that one has ADHD:

Inattention:
     • Difficulty paying attention, daydreaming
     • Does not seem to listen
     • Is easily distracted from work or play
     • Does not seem to care about details, makes careless mistakes
     • Does not follow through on instructions or finish tasks
     • Is disorganized
     • Loses a lot of important things
     • Forgets things
     • Does not want to do things requiring

Hyperactivity:
     • Seems “driven by a motor”
     • Cannot stay seated
     • Squirms and fidgets
     • Talks too much
     • Runs, jumps and climbs excessively
     • Cannot play quietly

Impulsivity:
     • Acts and speaks without thinking
     • Has trouble taking turns
     • Cannot wait for things
     • Blurts out answers before the question is finished
     • Interrupts others

One may say that anyone can exhibit such symptoms at one point in his life or another. Thus, certain criteria have to be met and an experienced clinician has to be the one to give the diagnosis. One very important factor is whether these symptoms are causing significant problems in school, in social relationships and in the home environment.

As earlier explained, children may seem to have ADHD symptoms at a point in their life. However, what sets apart a child who does have ADHD from one who doesn’t is the severity of the symptoms. The parents may notice this themselves, but oftentimes it is the teacher who first calls the parent’s attention to the child’s uniqueness. However, eliciting unbiased and accurate descriptions of the child’s behavior is critical to making an accurate diagnosis.

If the child demonstrates a significant number of the symptoms described in this brochure, a developmental evaluation is highly recommended.

WHAT ARE THE RISK FACTORS? WHAT CAUSES ADHD?
There is a genetic predisposition for ADHD, which means that there are members of the family (grandparents, parents, uncles/aunts, cousins) who also show the symptoms listed above. However, no specific gene has yet been identified as the ADHD gene.

Like many developmental conditions, the exact cause of ADHD cannot be pinpointed. What is known is that exposure to certain substances while the child is in the mother’s womb i.e. alcohol, nicotine, drugs of abuse or even infection can predispose a person to develop ADHD.

Brain imaging studies show a difference in brain structure and function within ADHD individuals, and it is believed that certain chemical mechanisms in the brain seem to be involved.

Like in all medical conditions, there is also the “nature and nurture” issue. One may be genetically predisposed for ADHD, or a certain environmental trigger (mother’s condition during pregnancy, chemicals, hormones, drugs, infection, family dysfunction, TV exposure, etc.) can cause the condition to manifest or come out.

WHAT HAPPENS WHEN A PERSON HAS ADHD?
ADHD may be difficult to diagnose because it is based on the observation of the trained clinician, with no laboratory tests to confirm it.

IT IS OFTEN SAID THAT IF YOU LOOK AT A TYPICAL TODDLER (AGE 1 1/2 – 2 YEARS), THIS MAY BE WHAT ADHD LOOKS LIKE.

The toddler period is the time when a child wants to be independent of his caregiver as he discovers his body’s capacity to do things he was earlier unable to do. Toddlers are motor-driven, adventure-seeking individuals who get into trouble and learn along the way. As a toddler grows older, he learns to limit himself and actively explores the environment in other less motor-driven ways.

In ADHD, even if the child matures and develops some self-control, the inherent restlessness, fidgetiness and desire for excitement remains. Some carry over this hyperactivity into adulthood, while others can manifest this as a hyperactivity of the mind (creative, out of the box ideas) or hyperactive mouths (chatterbox, talkative).

Many young children at the outset do not have the capacity to focus on a task for a sustained amount of time, have difficulty picking up what is essential to focus on or ignore what is not important. However, with normal maturity and practice, these behavioral traits are acquired. In ADHD, it seems as if the filtering mechanism never fully develops despite the usual exposure and upbringing. Thus, many children can’t mind their own business and are regarded as meddlesome.

A person with ADHD has the tendency to let his mind wander too frequently. These individuals are called forgetful, careless, absent-minded or “spaced out”. Sadly, they may be hard-working but unable to show evidence of their efforts because they forget things when they need them (like during exams) or make careless mistakes or skip items unintentionally. Other children with ADHD lack the ability to control their behaviors and act inappropriately for their age, tend to be impatient, blurt out or say things out of turn, have difficulty waiting and can be irritatingly present until he gets what he wants.

An important part of an ADHD individual’s problem stems from what is called Executive Function deficits, which cause him to act immature for his age. These functions include problems in:

     a. Organizing, prioritizing and activating himself to work
     b. Focusing, shifting and maintaining attention
     c. Regulating alertness, effort and processing speed
     d. Managing frustration and regulating emotion
     e. Utilizing working memory: access recall
     f. Monitoring and regulating himself

It is important to stress that the ADHD individual WANTS to act like the typical individual but has difficulty being consistent with it.

Often the person with ADHD will suffer from either problems in academic performance, work performance or social function. If these are not addressed right away, it may lead to complicating problems i.e. poor self-esteem, mood disorders like anxiety and depression and conduct problems, and substance abuse. As an older person, he or she may suffer from frequent vehicular accidents, underemployment, as well as marital and financial problems

HOW IS ADHD DIAGNOSED?
ADHD is diagnosed when the core symptoms of Inattention Hyperactivity-Impulsivity are present. It must occur to the extent that a person is unable to perform as expected, and causes significant difficulty or trouble. These traits must be consistent no matter where the person is – the home, school, social events or work. A diagnostic criteria requires six out of nine symptoms (as listed previously) to be present for diagnosis, and must occur before the age of 6. But even if the symptoms occur before age 6, diagnosis is made only after age 6.

It is important to diagnose ADHD early because a lot of the complications can be prevented. ADHD in itself is fairly simple to treat or manage. ADHD with the complications is much more difficult to treat. The likelihood of overcoming the problems of ADHD are much higher if ADHD is diagnosed and treated early.

If ADHD is suspected in younger children, they can already be monitored even without the diagnosis so that parenting and teaching can be much more effective.

WHAT ARE THE AVAILABLE TREATMENT OPTIONS?
Treatment of ADHD is aimed at managing the condition because it does not go away unlike previously believed. It is important for the individual and his family to understand that it is a chronic condition like diabetes or hypertension that needs long term management plans. Planning and reevaluation are important so that adjustments in strategies are made to fit the child’s needs.

Behavior Modification for Long Term-Management must focus on:
     • Target outcomes for behavior
     • Follow-up activities to sustain desired behavior
     • Monitoring
     • Education about ADHD is important for the child (in a language and level he understands), the family and any significant persons who interact closely with the ADHD child.
     • Teamwork among all professionals is necessary for proper diagnosis and successful, comprehensive and continuous management of the ADHD child.
     • The team includes parents, teachers, doctors, therapists, caregivers and other professionals.
     • Feedback and follow-up cannot be overlooked as strategies are evaluated and re-evaluated.
     • Medication must be recognized as having a beneficial role in management when warranted.
     • Parent Training and Teacher Training are also essential to the management plan.
     • Individual and Family counseling should not be overlooked.

ARE THERE CO-EXISTING CONDITIONS WITH ADHD?
ADHD exists alone only 1/3 of the time. It is often associated with other conditions such as Learning Disabilities, Language disorders, Motor Coordination problems, and Mood or Conduct disorders. Thus, if ADHD is diagnosed, one also has to be investigated for the other associated conditions. Also, if one is diagnosed with language disorders, learning problems/disorders, and mood/conduct disorders, ADHD must also be ruled out.

Furthermore, if ADHD is undiagnosed and unmanaged, other complications can develop or set in. Such complications are: learning problems/disabilities, school maladaptation/failure, oppositional-defiant disorders, conduct disorders and psychiatric conditions like bipolar, manicdepressive, and anxiety disorders.

WHAT SERVICES CAN TMC OFFER?
TMC, through its DPP Team Center, offers complete diagnostic services with a team of specialists which include the developmental pediatrician, child neurologist, child psychiatrist, adolescent specialists and neuropsychologist, to name a few. Intervention services through its Occupational and Speech therapists and Special Education Liaison are also available.

Furthermore, the DPP will be providing developmental promotion packages like parent seminars on behavior management, family counseling, etc. The DPP will also network with other institutions to deliver family support services and offers a venue for team conferences for a cohesive management package.

CENTER FOR DEVELOPMENTAL PEDIATRICS
Ground Floor, Podium Building
Ortigas Avenue, Pasig City, Metro Manila, Philippines
Tel. No. (632) 988-1000 / (632) 988-7000 Ext. 6630

CENTER FOR PATIENT PARTNERSHIP
Empowering patients to be our partners in the management of their health
Ortigas Avenue, Pasig City, Metro Manila, Philippines
Tel. No. (632) 988-1000 / (632) 988-7000 Ext. 6444
Email: mail@themedicalcity.com
www.themedicalcity.com

References:
- Attention Deficit Disorder: The Unfocused Mind in Children & Adults. Thomas Brown, PhD 2005 Yale University Press
- Taking Charge of ADHD. Russell Barkley, PhD 2000 Guilford Press
- Understanding ADHD. American Academy of Pediatrics
- Developmental-Behavioral Pediatrics. Wolraich, Drotar, Dworkin & Perrin 2008 Mosby Elsevier

Note: This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.   If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.