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Kurs: Zdrowie i medycyna > Rozdział 17
Lekcja 6: Zaburzenia rozwojowe układu nerwowego- Czym jest zespół Downa?
- Czym jest ADHD?
- Intro to neurodevelopment milestones
- Neurodevelopmental disorders: Sufficient and necessary causes
- What is cerebral palsy and what causes it?
- Types of cerebral palsy part 1 - Spastic
- Types of cerebral palsy part 2 - Dyskinetic and ataxic
- Diagnosing cerebral palsy
- Managing cerebral palsy
- Czym jest zaburzenie ze spektrum autyzmu?
- Czym jest zaburzenie ze spektrum autyzmu?
- What is Tourette's?
- Diagnosing autism spectrum disorder
- Managing autism spectrum disorder
- What is asperger syndrome?
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Czym jest ADHD?
Attention-deficit/hyperactivity disorder (ADHD)
If you’ve ever been to a child’s birthday party, the term hyperactivity will be familiar to you. Kids can be a whirlwind of running, giggling, yelling, poking, and interrupting fury. Although this energy can be exhausting for babysitters, parents, and teachers, it is a totally normal part of growing up. But for some kids (and some adults too!), the inability to control impulsive behavior or pay attention goes beyond the typical limitations of youth, and can cause serious problems at school, at home, and with friends.
- Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental (related to the way the brain grows and develops) disorder defined by persistent problems with attention, organization, and/or hyperactivity and impulsivity that interfere with daily life or development.
How do we pay attention, anyway?
Attention can be a tricky thing. Most of us feel like we can choose what to focus on and what to ignore. Email from cute coworker: Pay attention! Email from boss: Ignore! While choice certainly plays some role in attention, the majority of our focus happens without us even trying.
Try this: sit as quietly as you can for 30 seconds. Wherever you are, pay attention to your surroundings. What do you notice? A ticking clock, a buzzing light bulb, an itch on your leg, a conversation in the distance? These things are all around us all the time but we usually don’t notice them.
We only have so much attention to give at any one time. So, when we choose to pay attention to something (like reading), we rely on our brains to automatically filter out things that could distract us (like a buzzing light bulb). Scientists have identified several areas of the brain that work together to make this possible.
- Prefrontal cortex: helps with making plans and controlling inappropriate behaviors
- Basal ganglia/striatum: helps with motivation and choosing between different possible behaviors
- Cerebellum: helps process information and control our movement
- Corpus collosum: helps with integrating information from different parts of the brain
By working together, these areas of the brain allow us to choose what we want to pay attention to.
But what if our brains didn’t do this very well? What if, while you were trying to read this sentence, you were also noticing the ticking clock, and the buzzing light, and the itch on your leg, and the other conversation? It would be very difficult to get through the rest of this article.
You can think of the hyperactivity and impulsivity associated with ADHD in the same way. Some things we definitely choose to do (going to the movies) but most of our behaviors happen without much thought (you don’t have to think “I choose not to get up during the movie and run around the theater”, you just don’t do it). Because our brains automatically inhibit us from doing things we’ve learned are inappropriate, we are free to use our mental effort to make harder decisions. However, when our brains aren’t as effective at automatically eliminating possible choices of behavior, we can act on an impulsive behavior before we have had time to think about whether or not it is a good idea.
The same brain regions that are important for attention also help us control our impulses. That’s why, in the case of ADHD, atypical functioning in the brain areas mentioned above can lead to problems with attention, hyperactive/impulsive behavior, or both.
What are the symptoms of ADHD?
The symptoms of ADHD begin in childhood (usually between ages 3 and 6), and for about 50% children, continue into adolescence and adulthood. The primary symptoms of ADHD fall into two categories: inattention and hyperactivity/impulsivity. While these symptoms can be present in children or adults, the specific presentation of symptoms is usually different at different ages.
| Symptoms | ||
|---|---|---|
| Inattention | Failing to pay attention to details that leads to careless mistakes | |
| Often not seeming to listen when being spoken to directly | ||
| Often having difficulty with sustained attention, organization, follow through | ||
| Often easily distracted | ||
| Hyperactivity/impulsivity | Constant fidgeting, tapping hands or feet, squirming in chair | |
| Often leaving seat when sitting is expected | ||
| Often talks excessively | ||
| Often interrupts or intrudes on others |
How is ADHD Diagnosed?
ADHD is not diagnosed by a simple test or interview. Because most people experience the symptoms of ADHD sometimes, it’s very important for health care providers to talk to the parents/caretakers, teachers, friends, and coworkers of anyone being assessed for ADHD, to better understand how the symptoms affect different areas of a person’s life.
To be diagnosed with ADHD, the symptoms must be present in more than one setting (e.g., at school and at home), continue for more than six months, and must be significantly worse than what would be expected given the person’s age. Other conditions (like oppositional defiant disorder, intellectual Disability, or substance use disorders) need to be ruled out before a formal diagnosis of ADHD can be made.
There are three subtypes of ADHD. These subtypes are based on whether a person has inattentive symptoms, hyperactive/impulsive symptoms, or both.
What are the causes of ADHD?
The exact cause of ADHD is unknown, but developmental differences in areas of the brain responsible for attention and behavioral control are thought to be involved.
Surprising to some, the vast majority of research suggests that things like eating too much sugar, watching too much television, or living in a chaotic household do not cause ADHD.
How common is ADHD?
ADHD occurs in most cultures, and affects about 5% of children and 2.5% of adults worldwide.
Can ADHD be prevented?
Because the exact cause of ADHD is unknown, it is unclear what can be done to prevent it. With that being said, taking steps like avoiding drugs and alcohol (or other toxins) during pregnancy may reduce a child’s risk of ADHD.
How is ADHD treated?
Although there is no cure for ADHD, there are several treatments that can effectively reduce symptoms. ADHD is typically treated through a combination of medication, behavioral therapy, and family and school education.
Medication:
- A class of medications called stimulants is often used as a first step in treating ADHD. Stimulants work by increasing the amount of the chemical dopamine that is circulating in the brain. For people without ADHD, this surge of dopamine is very energizing (that’s why drugs that release dopamine are called stimulants!). Ironically, for people with ADHD, the increased dopamine seems to be calming and can help improve focus and behavioral control. Common side effects of these medications include reduced appetite and trouble sleeping. Medications work well to reduce ADHD symptoms right now, but unfortunately do nothing to reduce future symptoms (as soon as the pills wear off, your symptoms return).
There is some controversy about whether it is appropriate to treat children with stimulants (after all, cocaine works by releasing dopamine too). While the decision to use medication is a personal one that should be made with the assistance of a healthcare provider, stimulant medications have largely been found to be safe and effective in reducing the symptoms of ADHD.
Behavioral therapy:
- Behavioral therapies focus on developing skills and strategies to counteract the symptoms of ADHD. These skills can range from practical things like organization and studying tools, to social skills training (understanding other people’s emotions, waiting your turn, etc.). Through working with a therapist, a person with ADHD learns to focus on the consequences (both good and bad) of their actions, which can help reduce hyperactivity and impulsivity. Behavioral therapy works well to reduce the problems caused by ADHD in the future, but doesn’t work as well as medication in reducing symptoms right away.
Family and school education:
- Living or working with someone with untreated ADHD can be very difficult. Particularly for parents and teachers, dealing with the symptoms of ADHD can lead to frustration, guilt, anger, and exhaustion. These feelings can actually lead to even worse outcome for the person with ADHD. For example, a child with ADHD who is having trouble sitting still in school (at risk for poor academic performance) is constantly sent to detention because his teacher is frustrated by his distracting behavior (putting him at even greater risk for poor academic performance). Working to educate families and teachers about how to manage the needs of a child/student with ADHD is a very important part of treatment.
Consider the following
ADHD can be found all over the world, but it is most prevalent in cultures that have required schooling for all children. Why might that be? (Hint: It probably isn’t that elementary school is causing ADHD). You can think of attention or behavioral control just like any other trait humans have: some people can naturally do it very well, others not so well. While these abilities may be mostly unchangeable, they are only helpful/hurtful in certain situations.
For instance, some people can fold their tongue like a taco, other people can’t. However, not being able to fold your tongue isn’t harmful, because you’ll probably never be put in a situation where the skill of tongue-folding will be required to succeed (ever been asked to fold your tongue in a job interview?).
Cultures with required schooling commonly put kids in situations (classrooms) where skills like attention and behavioral control are very important to success; making poor performance in these areas much more noticeable and problematic. This leads to higher rates of ADHD diagnosis. When you are thinking about ADHD, keep in mind that it’s not just the brain differences that determine how harmful the symptoms are, it’s also the situation.
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