Introduction
Attention Deficit and Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that is largely genetic in origin. The brains of people with ADHD do not work the same way as those without the disorder. Neurotransmitters are chemicals in the brain that make it possible for nerve cells to communicate with one another. In ADHD sufferers, there are insufficient neurotransmitters present in the area of the brain that is responsible for regulating attention and behavior. Dopamine and norepinephrine, the faulty neurotransmitter systems, are responsible for governing the executive functions of the brain, hence those with ADHD have trouble planning and organizing their lives and controlling their emotions. Samoon Ahmad, M.D. adds, “Beyond genetics, some other factors the team cited include childhood exposure to high levels of lead, infant hypoxic-ischemic encephalopathy (when newborns do not receive enough oxygen to their brains), and prenatal exposure to nicotine.”
Management of ADHD includes a combination of medication, counseling, and lifestyle changes. Research has proven that medication itself will not cure the symptoms of the disorder, and psychotherapy is necessary to help the individual learn to live with the condition.
Medication
Medication works by increasing the dopamine in the brain. The effect of this is that the patient is able to focus and is less impulsive. Stimulants are normally prescribed for ADHD, and these have shown short-term benefits, reducing the symptoms in up to 80% of the children taking them. “Up to 80% of patients with Adult ADHD respond to medication. This is significantly higher than the 50-60% of depressed patients who respond to antidepressants,” Scott Shapiro, M.D. wrote. Stimulants take effect quickly, and only a few people have side effects. However, the medication does not completely normalize behavior. Non-stimulant drugs are also available, and therapy and behavioral treatments must be considered as alternatives to medication. The effectiveness of treatment with stimulants is unclear. Adults and adolescents learn coping mechanisms, which reduce the observable symptoms of ADHD over time.
Response to the medication differs between individuals. The medical professional will determine the dosage and drug combination and may change the combination a few times before settling on the best blend for the patient. Side effects can include sleep problems, irritability, increased blood pressure, decreased appetite, stomach ache or headache, and depression and anxiety. If the side effects cannot be managed, then other drugs may have to be considered. All side effects should be discussed with the prescribing doctor. Between 30% to 50% of patients will stop taking the medication within a year, and between 66% and 80% within three years.
Studies have shown that there is neither an increased nor a decreased risk of later drug use if the child is given stimulants to control behavior. Medication is generally not used in preschool children, as stimulants are known to cause mood problems and slow down growth in children under six. Research suggests that overdiagnosis of ADHD is a problem and that children tend to be over-medicated. This is a concern as unnecessary treatment of children can lead to unnecessary side effects.
Parent Training
Parent training has been found to be very effective in the management of the symptoms of ADHD and will be the first line of treatment for preschoolers and children with mild symptoms of ADHD. “For more than two decades, psychosocial interventions such as parent training and behavioral modifications have been used for children with ADHD,” James Haggerty, MD, says. Parents are trained to make the home environment ADHD-friendly through organization and routines. They are taught how to modify the child’s behavior by setting age-appropriate rules, rewarding appropriate behaviors, and punishing inappropriate behavior.
Psychotherapeutic interventions
Psychotherapeutic interventions include Cognitive Behavioral Therapy and Behavioral Therapy. During cognitive behavioral therapy, the child is encouraged to talk about the things that upset him. This helps to build up self-esteem, as it seeks to explore ways to handle daily problems and control of aggression. Behavioral therapy seeks to correct behavior by helping the individual learn organizational skills and by helping them cope with problems of emotional control.
Social Skills
Normally, children learn social skills by watching others. However, children with ADHD will have difficulty learning social skills and will have to be taught these skills, which include waiting their turn, sharing, and emotional control. The inclusion of aerobic exercise in lifestyle change is very important as it is known to reduce the symptoms of anxiety and depression and to improve the symptoms of ADHD. Participation in a sport will also help improve social skills and reduce the time available for solitary occupations.
Conclusion
Medication, behavior modification, and training in social skills will all form part of the treatment plan, which has as its goal the reduction of the long-term psychological problems known to plague the sufferers of ADHD.
References
http://www.webmd.com/add-adhd/guide/adhd-adults#4
https://www.forbes.com/sites/noodleeducation/2017/02/15/adhd-a-beginners-guide/#766610bd4540
http://www.psychiatrictimes.com/special-reports/are-we-overdiagnosing-and-overtreating-adhd
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0169277
http://www.health.com/health/gallery/0,,20441463,00.html
http://metro.co.uk/2017/01/28/whats-it-like-to-be-an-adult-with-adhd-6411245/
https://psychcentral.com/disorders/adhd/treatment-for-attention-deficit-hyperactivity-disorder-adhd/
https://psychcentral.com/lib/additional-treatments-for-adhd/