• 02
  • Sep

Understanding ADHD

The word ADHD brings to mind the hero of a popular animated cartoon series “Dennis the Menace” by Hank Ketcham. It portrays the misadventures of a naughty five year old boy Dennis Mitchel. I would say that Dennis personifies nearly all the clinical symptoms of ADHD like exuberant energy, impulsivity & carelessness.

Historically the  first mention of a disorder similar to ADHD was by Alexander Chrichton in 1798. In early 1900, British pediatrician described ADHD as an “abnormal behavior shown by a group of intelligent children.” Fidgety Phil by Hoffman is another narrative that depicts children with ADHD as ones with “motoric over activity.”

ADHD is a neurodevelopment disorder of childhood onset with a persistent pattern of inattention & hyperactivity - impulsivity. It is prevalent in 6-12% of school aged children. The vulnerability for ADHD primarily comprises genetic & environmental risk factors. Prenatal associations include maternal smoking, consumption of alcohol, hypothyroidism & emotional stress during pregnancy. The prevalence is higher in preterm & low birth weight children.

Symptom profile during the school going ages include emergence of extreme over activity & inattention leading to poor scholastic performance. Comorbidity with specific learning disorders is seen very often. The next major pinch point in ADHD life journey occurs during the transition from childhood to adolescence. While overall levels of hyperactivity may start to recede, impulsivity and inattention continue to constrain adolescent adjustment. Risk for onset of defiant behaviors and  early onset substance use disorders exist. ADHD persists to adulthood in nearly 30% - 40% cases and diagnostic criteria for adult ADHD have been formulated. Overt ADHD symptoms reduce and are often replaced by feeling of internal agitation & restlessness, increased risk for mood and anxiety disorders, poor organizational skills.

The treatment for ADHD is multimodal. Medications are the cornerstones of therapy and effectively decrease core ADHD symptoms. Methylphenidate is currently the first line drug in the treatment armamentarium. The nonstimulant atomoxetine & clonidine are among the alternate options. Between 85 to 90 percent of children with  ADHD will respond to one of the available medications. Behavior therapy, parent training strategies, classroom management are some of the psychological treatment modes.

The current scientific advances in ADHD research clearly disprove the age old myths that children with ADHD have low intelligence and are doomed to be poor performers. The balance of judicious pharmacotherapy, hand in hand with psychological therapies assures a promising future for the “Fidgety Phils.”

Dr. Deepa Deepak