Understanding Attention Deficit Hyperactivity Disorder

Dr Meesha Haorongbam
Some of us have had friends who were often disruptive and fidgety in classrooms; the ones who often got in trouble with teachers for their constant interruptions and for failing to do their class assignments in time. They’d talk to us during lectures leading to everyone getting punished by the teacher. When they came over to our house to play, they seemed all over the place; they’d be jumping or running around all over the house. As adults, some of our colleagues may have trouble initiating or completing a task, difficulty with multitasking, zoning out during important conversations, and are often extremely distractible. If asked, we’d describe then as “edgy” or “tense”. They’re often labelled as dreamers, slackers, trouble-makers or “bad students”. As annoying as their traits seem to us, they are struggling with a neuropsychiatric disorder known as “Attention Deficit Hyperactivity Disorder” or “ADHD” in short.
What is ADHD ?
ADHD is highly common yet often misunderstood or misdiagnosed. As the name suggests, inattention and hyperactivity or impulsivity are the core components of the illness, thereby affecting people’s behaviour.   Based on the diagnostic criteria and assessment tools used, global prevalence of ADHD ranges from 1-19%. In India, it is reported to be 1.6%-17.9%. It is more prevalent in boys than girls with the ratio ranging from 2:1 to as high as 9:1. ADHD often presents by 3 years of age, but unless they are very severe, the diagnosis is frequently not made until the child is in primary school, when teacher information is available comparing the index child peers of the same age.
What causes ADHD ?
While the exact cause for ADHD is unknown, studies have found that the following factors have potential roles in causing ADHD: genetics, brain injury, toxic environmental exposures, alcohol and tobacco use and/or maternal infections during pregnancy, premature delivery and low birth weight. Psychosocial factors such as severe chronic abuse, maltreatment, and neglect also contribute to development of ADHD.
What are its symptoms ?
There is no uniform presentation of symptoms. It may be presented as (a) predominantly inattentive,  (b) predominantly hyperactive/impulsive, or (c) combined presentation
The main signs of inattentiveness include, but are not limited to:
· Difficulty in organizing tasks
· Constantly changing activities or tasks
· Short attention span
· Easily distracted
· Appearing forgetful
· Inability to stick to tasks that are tedious or time consuming
· Inability to listen to or carry out instructions
The main signs of hyperactivity and impulsiveness include, but are not limited to:
· Inability to sit still, especially in calm or quiet surroundings
· Markedly excessive fidgeting and wriggling during spontaneous activities
· Inability to concentrate on tasks
· Excessive physical or verbal movements
· Difficulty awaiting turns in games or group situations
· Acting without thinking
In adults, ADHD has slightly different symptoms which manifest as:  struggling to complete tasks, tardiness, tendency to overlook details, easily bored and seeking out new stimulating experiences, tendency to procrastinate, frequently losing or misplacing things, poor self control, addictive tendencies, being easily flustered, trouble staying motivated etc
What are its effects ?
ADHD makes the person feel like constantly struggling to keep their head above water and they’re often overwhelmed by the stress caused by procrastination and disorganization. Undiagnosed and untreated ADHD causes problems in every aspect of one’s life :
1. Health: The symptoms of ADHD may contribute to a variety of physical and mental health problems such as substance abuse, anxiety, depression, eating disorders, sleep disorders etc.
2. Academic and career: Easy distractibility, inattention, difficulty in completion of assignments, ability to learn, etc are hampered by ADHD. This leads to poor academic performance. As adults, they have trouble meeting deadlines, completing detail oriented tasks, and managing finances.
3. Relationship : As those with ADHD are often perceived as irresponsible, lazy, stupid or insensitive, it can put a strain on their relationships with their loved ones.
How is a diagnosis helpful ?
A diagnosis of ADHD is made after careful examination by healthcare professionals with expertise in ADHD after obtaining information from various sources eg teachers, colleagues etc. Diagnosis is helpful as it helps in formulating a treatment plan. As mentioned above, undiagnosed ADHD can wreak havoc in the person’s life as well as in the lives of their loved ones. More importantly, a diagnosis of ADHD gives relief and hope to the affected individuals, who go through life feeling they’ll never be able to get their life under control or fulfil their potential. It helps them and the people around them realize that their difficulties are due to a biological condition and not defects in their character.
Common misconceptions
ADHD is over diagnosed: Disparity in diagnosis depends on the diagnostic criteria used and more importantly on awareness. Eg more awareness leads to more evaluations leading to more diagnosis
ADHD is a character flaw : Inattention, distractibility, and impulsivity are the outcomes of a neurobiological disorder. They are not character flaws.
ADHD is under your will : Research backs the fact that the harder one tries, the worse the symptoms seem to get.
You can outgrow ADHD : While you can outgrow hyperactivity, the inattentiveness and impulsivity that cannot be outgrown causes impairments in academic, personal, and occupational life unless treated.
Regardless of the age at diagnosis, ADHD is treatable though treatment initiation at a younger age would have more impact. Various treatment modalities are essential such as medications, behaviour therapy, parent training and education programmes, social skills training, cognitive behavioural therapy, and organizational strategies.
How can we help ?
People with ADHD are not uncaring, irrational, or unreliable. Rather, they are acutely aware of failing to live up to neurotypical expectations. So when their loved ones mirror those feelings with words or actions it validates their embarrassment and frustration. There are minor steps we can take which in the long run would have a profound positive impact on our loved ones struggling with this disorder:
1. Educate yourself and others about this condition. As parents, learn how ADHD affects your child in school, at home and in social gatherings and what parenting techniques to be implemented. As friends and colleagues, empathise with their illness and their struggles.
2. Encourage them to seek professional help.
3. Help them disclose their diagnosis.
4. Remember, ADHD is not a sign of one’s intelligence and capability. It is an illness. And like all illnesses, proactive steps should be taken to regain control over their lives.

The writer is a Psychiatrist, she can be reached at [email protected]