What is ADHD?
Attention deficit hyperactivity disorder (ADHD) is a developmental impairment of the brain’s executive functions. It is most often caused by genetics and runs in families. Some ADHD specialists refer to ADHD as a disorder of self-regulation. Self-regulation requires that a person have intact executive functions.
Executive function refers to brain functions that activate, organise, integrate and manage other functions. It enables individuals to account for short and long term consequences of their actions and to plan for those results.
ADHD is a thoroughly researched condition and the World Health Organisation states that ADHD occurs in 5.26% of the population. 1 in 20 children have ADHD and can present in a mild, moderate or severe form. ADHD can look different in girls and boys. Girls show mostly the inattentive type of ADHD called ADD. ADHD is also linked to other childhood disorders like ODD and learning disabilities.
There are many unspoken aspects of ADHD like rejection sensitivity, hyperfocus, masking, etc. which are not included in the DSM. ADHD is usually treated with medication and therapy.
Schools can also provide accommodations for the child with ADHD to make learning better and more effective.
There are strategies that parents can use to help and guide their child. Children with ADHD have different learning styles and can benefit from certain strategies such as body doubling for better concentration. ADHD is much more common than we realise and there are many celebrities and athletes who were diagnosed with ADHD and were able to find success in their careers.
Is ADHD curable?
About 33% of children appear to grow out of ADHD. This doesn’t mean that ADHD gets cured, it is just that the impairment gets so insignificant it cannot be detected. However, in 66% of children, some amount of attentional difficulties will continue to stay and they will meet criteria for at least mild to moderate Attention difficulties.
Historically, ADHD was seen as a child disorder. Often, it is assumed that if you are not diagnosed as a child or adolescent, you cannot be diagnosed with ADHD. however this is not true.
In our clinic as well as internationally, often adult parents are being diagnosed when their child is being diagnosed because this is heavily genetically connected. We know through research that about 80% of ADHD is genetic. This is also your experience during your child’s initial assessment when parental tendencies were discussed in detail.
ADHD Treatment at STEPS
Treating any disorder or tendency requires us to first understand its severity and the areas in life that are impacted. In population-based studies, diagnosable ADHD is seen in about 5 to 10% people with ADHD and one can assume that there is another 10% with subclinical or compensated ADHD. This calculation takes the prevalence of clinical as well as subclinical ADHD to be 20%.
In children and adolescents, as part of the intake assessment, we try to quantify the severity of ADHD as well as any difficulties that make ADHD easier or harder to handle.
- Therapy and parent work: Once areas of difficulties have been identified, it is very important for the child and the parents to understand and accept both the areas of difficulties as well as strengths. Strategies for ADHD require a certain amount of trust between both parent and child. This is the main thrust of treatment. Acknowledgement of the child’s strengths and weaknesses and allowing parents, friends, tutors to support the areas of difficulties.
- School supports: once the above process has been started, we need to optimise school supports. This requires a certain ring if the child needs any accommodations at school for example if time management is an issue, the child would benefit from 25% extra test time as he is unable to use the given time most effectively.
- Medication management: this is decided on a case-by-case basis specially for children and adolescents who have moderate to severe symptoms. ADHD medications are very well researched and have been around since the 1950s. The approach to medications is to be objective, not to overvalue them but not to devalue them either. Since this is a nuanced issue, it will be addressed later in more detail.
ADHD : Subtypes
The term Attention Deficit HyperActivity Disorder is somewhat of a misnomer. It is not a disorder of attention deficit but of attention dysregulation. Which means that attention can be excessively low or excessively high depending on the situation and task at hand and not necessarily what the child wants to do. A child might want to complete homework but their attention at that point might be extremely low (considering that most children don’t want to do homework) as compared to other children their age.
ADHD can be broken into three types of disorders. These are
Hyperactivity and Impulsive Type ADHD
In hyperactive ADHD people feel the need for constant movement. They often fidget, squirm, and struggle to stay in their seats. Children often appear to be “driven by a motor” and run around excessively. People may also talk alot, interrupt others, blurt out answers, and struggle with self-control. This type of ADHD is more easily noticed as it is most disruptive at school and at home and more often diagnosed in young boys.
Inattentive Type ADHD
People having inattentive ADHD aren’t able to focus, make careless mistakes because they have difficulty sustaining attention, following detailed instructions, and organizing tasks and activities. They are easily distracted and often lose things. This type of ADHD is more commonly diagnosed in adults and girls.
Combined Type ADHD
People having combined-type ADHD demonstrate six or more symptoms of inattention, and six or more symptoms of hyperactivity and impulsivity.
ADHD Diagnosis in Girls
Experts suggest that one of the key reasons ADHD in girls is so often overlooked is that they exhibit hyperactivity differently than boys. For example in a classroom setting, a boy might continually blurt out answers or repeatedly tap his foot, whereas a girl might demonstrate hyperactivity by talking incessantly. A girl who talks all the time is often viewed by the teacher as chatty, not hyper or problematic and thus is less likely to be recommended for an evaluation.
Another reason that ADHD is often missed in girls is that they’re more likely than boys to exhibit inattentive ADHD. The symptoms of this sub-type (which include poor attention to detail, limited attention span, forgetfulness, distractibility, and failure to finish assigned activities) tend to be less disruptive and obvious than those of hyperactive ADHD.
Some girls also compensate by developing strategies that mask their ADHD. For instance, a girl might spend hours taking notes on each chapter she’s being tested on in order to assure a good grade or she might check and recheck her backpack to make sure she has everything.
In the current criteria of ADHD, social emotional aspects of ADHD which are more prominent especially in girls don’t find mention. Examples might include Impact of the following behaviours – being aloof in the uninteresting conversation, blurting out something politically incorrect or inappropriate, not responding to people’s messages on time – this leads to lack of social success and dissatisfaction and low self-esteem.
There are ADHD symptoms that are common in girls. For example, they may:
- Have a hard time focusing and listening to instructions
- Daydream often
- Try to avoid doing things that require a lot of attention
- Seem forgetful
- Lose things often
- Have a messy book bag or room
- Struggle to concentrate at school or make silly mistakes
They could also display the following symptoms more than boys:
- Stress
- Anxiety
- Low self-esteem and a tendency to be more self-critical
- Depression
- A higher chance of self-harm
Resources
https://www.webmd.com/add-adhd/childhood-adhd/adhd-symptoms-girls
https://www.additudemag.com/adhd-in-girls-women/