Breaking down Attention Deficit Hyperactivity Disorder (ADHD).

Attention Deficit Hyperactivity Disorder, or ADHD for short, is a neurodevelopmental condition that involves ongoing issues with inattention, hyperactivity, and impulsivity. The symptoms stem from executive dysfunction, which means there's a hiccup in how the brain manages and controls thought processes. There are three main types of ADHD based on these symptoms: the predominantly inattentive type, which is all about a lack of focus; the predominantly hyperactive-impulsive type, where there's a lot of activity and acting on impulse; and the combined type, which mixes both sets of symptoms and is the most common, affecting about 62% of people with ADHD. Signs of inattention might include frequently missing details or making silly mistakes, struggling to stay focused on tasks or conversations even without distractions, not following instructions, having trouble organizing tasks, misplacing things, and being forgetful. Interestingly, females often show more signs of inattention and distractibility rather than hyperactivity. On the flip side, hyperactive-impulsive symptoms can involve difficulty sitting still, fidgeting, talking non-stop (including interrupting others), or having a hard time waiting for turns, like in a queue. As people age, these symptoms can evolve.

Poor handwriting and dyslexia are more common among individuals with ADHD. On top of that, emotional dysregulation is seen as a key characteristic, which refers to emotional reactions that don’t align with what’s typically expected. This might look like throwing tantrums, having angry outbursts, crying in situations that don’t seem to bother others, or getting easily stressed and frustrated over minor tasks. However, pinpointing where normal emotional responses end and abnormal ones start can be tricky.

When it comes to ADHD complications, about two-thirds of kids with ADHD also deal with other mental health issues like anxiety and depression, sleep disorders, autism spectrum disorder, or learning disabilities. ADHD can carry into adulthood for 30 to 50 percent of those affected. This can lead to social challenges, such as trouble finishing school or keeping a job. There’s also a higher chance of substance abuse issues among ADHD patients and an increased risk of suicide across all ages. Additionally, ADHD individuals are overrepresented in the prison system, with some studies indicating a 25% incidence rate.

As for the pathophysiology of ADHD, the exact mechanisms aren’t completely clear, but it’s believed to stem from changes in the production or functioning of certain brain chemicals.

Dopamine and noradrenaline are key players as neurotransmitters in our nervous system, particularly in the mesolimbic dopamine pathway and the locus coeruleus noradrenergic system. They play a big role in executive functions and how we respond to stress, which are believed to be crucial in the development of ADHD. Studies have shown that the anterior cingulate gyrus and dorsolateral prefrontal cortex are smaller in individuals with ADHD, possibly explaining their challenges with goal-directed behavior.

When it comes to the causes of Attention Deficit Hyperactivity Disorder, genetics seem to have a significant influence, with heritability estimated at around 74%. This means that genes can greatly affect how traits differ among individuals. Siblings of kids diagnosed with ADHD are three to four times more likely to have it as well. Environmental factors also play a big role, especially those related to pregnancy and birth. For instance, exposure to alcohol, smoking, or pesticides during pregnancy, along with low birth weight and premature births, can increase risk. Infections during early childhood, like rubella or varicella zoster virus, are also linked to ADHD. Some research suggests that about 30% of children who suffer traumatic brain injuries may later develop ADHD.

As for diagnosing Attention Deficit Hyperactivity Disorder, it’s primarily clinical, meaning there aren’t any specific lab tests or imaging that can confirm it. The diagnosis relies heavily on patient history. The DSM-5 outlines criteria for ADHD, which includes various subtypes and lists nine long-term symptoms related to inattention or hyperactivity-impulsivity.

Kids need to show nine or six symptoms, while teens and adults only need five. These symptoms should have been noticeable between ages 6 and 12 and should impact more than one area of life. They also need to cause some issues in social settings, school, or work. Treatment usually involves medication and therapy, with behavioral therapies being the go-to for mild cases or younger patients. Options like cognitive behavioral therapy, psycho-education, interpersonal therapy, and family therapy can be helpful too. When it comes to medication, stimulants like amphetamines or methylphenidate are the main choices since they work as dopamine and noradrenaline reuptake inhibitors, aligning with the suspected causes of the disorder. Amphetamines can also boost dopamine release. About 70% of patients see positive results with these meds, but keep an eye out for side effects like trouble sleeping, higher blood pressure, and less appetite. There are also non-stimulant options like antidepressants and alpha adrenergic agonists. Atomoxetine is a popular choice as a noradrenaline reuptake inhibitor, and bupropion is another alternative. Guanfacine and clonidine are alpha adrenergic agonists that work well, especially for kids and teens. Plus, adding exercise to the mix has shown to be helpful too.