Understanding ADHD: Diagnosis and treatment

ADHD stands for Attention-Deficit/Hyperactivity Disorder. It is a neurodevelopmental disorder characterised by inattention, inability to focus, and hyperactive, impulsive behaviour.

ADHD symptoms usually appear in children younger than 12 years of age, but symptoms may present in kids as young as three. While it predominantly ails children, ADHD can last into adulthood. According to the American Psychiatric Association, approximately 8.4% of children and 2.5% of adults in the United States have ADHD.

ADHD has no known cure, but a combination of medication and behavioural therapy, like neurofeedback and cognitive behaviour therapy, can help one manage and cope with ADHD symptoms.

Types of ADHD and specific symptoms

ADHD has three types, predominantly inattentive, predominantly hyperactive/impulsive, and combined.

Note:Being diagnosed with predominantly inattentive ADHD does not preclude the presence of hyperactive/impulsive symptoms. It simply means inattentive symptoms are more predominantly present than hyperactive/impulsive symptoms.

1. Predominantly Inattentive presentation

People with Predominantly Inattentive Presentation ADHD are forgetful and easily distracted. They are unable to focus, and they find it difficult to finish tasks. Obeying clear instructions and following conversations can also be a challenge.

Inattention symptoms

The following are the inattention symptoms based on the Diagnostic and Statistical Manual of Mental Disorders standards:

• Frequently makes careless mistakes, often failing to pay close attention to details
• Frequently finds it difficult to sustain attention to tasks or activities
• Frequently appears inattentive even when spoken to directly
• Frequently unable to follow instructions or complete schoolwork, chores, or duties
• Frequently reluctant or unwilling to perform tasks that require focusing for an extended period of time [e.g., answering SAT test preparation worksheets]
• Frequently loses things, especially those that are crucial in tasks and activities
• Usually easy to distract
• Usually forgetful
• Often finds it challenging to organise tasks and activities.

2. Predominantly Hyperactive/Impulsive presentation

Those diagnosed with Predominantly Hyperactive/Impulsive ADHD appear restless, fidgety, and jittery. They find it challenging to sit still and keep quiet for a long time, so they are constantly moving and talking. Young children can constantly be running, climbing, and jumping. Older children and adults, however, may continuously fidget and appear restless.

Hyperactive-impulsive children and adults find it hard to wait their turn at anything. They find it difficult to listen to other people, and they often interrupt or grab things from others. Their impulses lead them to speak inappropriate things at inappropriate times.

Hyperactive/Impulsive symptoms

The following are the symptoms of hyperactivity or impulsiveness:

• Frequently displays fidgety behaviour such as tapping of hands and feet and squirming in their seat
• Frequently behaves contrary to expectations, such as leaving one’s seat when everyone is expected to remain seated
• Frequently displays inappropriate behaviour such as running, jumping, and climbing in young children and evident restlessness in older adolescents and adults
• Frequently unable to be quiet, even in leisurely activities where such is expected
• Frequently very energetic
• Frequently unable to stop talking; talks too much
• Frequently answers before the question has been completed
• Frequently unable to wait in line or wait one’s turn
• Frequently interrupts others in their conversations or activities.

3. Combined presentation

Those diagnosed with Combined Presentation ADHD have combined symptoms. Neither the inattentive nor the hyperactivity/impulsive symptoms dominate. Instead, symptoms from both types are equally present.

Diagnosis of ADHD

To be diagnosed with attention deficit, one must:

• present at least six inattention symptoms if 16 years or younger or at least five inattention symptoms if 17 years or older
• be at a developmental level where such symptoms are inappropriate
• have had the symptoms for at least six months.

To be diagnosed with Hyperactivity/Impulsiveness, someone must:

• present at least six hyperactivity/impulsiveness symptoms if 16 years or younger or at least five symptoms if 17 years or older
• be at a developmental level where such symptoms are inappropriate and disruptive
• have had the symptoms for at least six months.

Additionally, the following must be satisfied before a person can be diagnosed with Inattention, Hyperactive/Impulsive, or Combined Presentation ADHD:

1. There must have been several ADHD [inattention or hyperactive/impulsive] symptoms before age 12
2. Several ADHD symptoms must be present in at least two settings; if the symptoms present themselves only in school and nowhere else, they may not be due to ADHD
3. The observed symptoms must be demonstrably interfering with his quality of life or how he functions in his daily activities
4. No other mental disorder can explain the observed symptoms better.

Treatment of ADHD

If a child, an adolescent, or an adult has been diagnosed with ADHD, the doctor may use medication, therapy, or a combination of modalities to treat the symptoms of ADHD.

Treatment plans will vary depending on what’s best given the particular circumstances. For instance, the recommended course for children six years old and below diagnosed with ADHD is behaviour management training for the parents. Such training will equip the parents with the skills and strategies to deal with and help their children.

In older children, a combination of medication and behavioural therapy is advised. The behavioural therapy will be for both the parents and the children.

Neurofeedback Training for ADHD

Your doctor can recommend neurofeedback training to manage ADHD symptoms.

Neurofeedback training is essentially brain training therapy. It trains the brain to self-regulate, thereby effectively and positively impacting your behaviour.

Neurofeedback training is non-invasive. You will sit comfortably while watching your favorite movie or TV show. Meanwhile, strategically placed sensors monitor your brain wave activity. When your brain does something right [e.g., focuses on what is happening on the screen], the system rewards you with a clearer sound and picture. This reward tells your brain about which brain activity is desirable and gives your brain instant feedback whenever the desirable brain activity occurs.

Over time and after many repetitions, your brain will start regulating its brain wave activity to realise the reward, which is a better sound and picture. Consequently, your brain becomes empowered to control your brain activity, which means it will be better at controlling the symptoms of ADHD.

Diagnosis is key

ADHD is a neurodevelopmental disorder. If it seems like you or someone you care about has inattention or hyperactive/impulsive symptoms, consult a doctor and get a diagnosis.

Diagnosis is crucial because only after there is an accurate diagnosis can treatment begin. And getting an early diagnosis means you can start treatment much earlier, too.