All about ADHD

The most common neurodevelopmental disorder

Between 5% to 8% of children are diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). The condition affects brain function and development, mainly, and is characterized by:

• inattention: an excessive and chronic lack of focus

• impulsivity: impulsive behaviour

• hyperactivity: high levels of physical restlessness

ADHD, executive function and self-regulation

Since ADHD is a disorder of executive functions and self-regulation, it can have a significant effect on learning and behaviour. Both children and adults with ADHD may also have difficulty regulating behaviour and emotions appropriately.

Self-regulation

Self-regulation is a process that involves managing emotions to meet the demands of a given situation. Self-regulation processes include:

• resisting highly emotional reactions to upsetting stimuli

• calming down when upset

• adjusting to a change in expectations

• handling frustration without an outburst

Emotions

Both positive and negative emotions play a critical role in executive functions and self-regulation. Self-regulation informs our ability to access our executive functions, which guide our behaviour. In turn, executive functions inform our ability to manage emotions, or self-regulate.

Executive functions

Executive functions are cognitive processes that help manage our emotions and behaviour:

• time management

• organization

• effort

• directing focus

• completing tasks

• getting organized

• being still when required

• paying attention to details

• thinking before acting and speaking

• behaving in appropriately

• working memory

• problem-solving

• decision-making

• cause-and-effect thinking

• impulse control

What Causes ADHD?

ADHD research has been included in medical documents for over 100 years

Research indicates that ADHD is highly heritable, meaning it often runs in families. Other causes of ADHD include:

• Exposure to toxins (i.e., lead or pesticides)

• Early adverse experiences (i.e., premature birth, low weight, and brain injuries)

What Does NOT Cause ADHD?

Although these factors do not cause ADHD, they can increase or worsen symptoms of ADHD in children.

• Poor parenting, (parenting style CAN impact symptom severity, learning and skill-acquisition)

• Screen time

• Eating too much sugar

• Traumatic experiences

• Family stresses and/or conflict

• Lack of exercise

• Acetaminophen

The ADHD Brain

Researchers have found differences in brain structure, connectivity, neurotransmitters, and maturation in individuals who have ADHD compared to people who don’t.

Brain Structure

Research has found that children diagnosed with ADHD may exhibit comparatively decreased size of certain brain structures, as compared to their neurotypical counterparts.

Brain Areas and Functions

The amygdala

• emotional responses (fear, anger, sadness)

• threat-detection and response

• learning

• memory

• more

The putamen

• learning

• planning

• motor-skills

• movement

• The basal ganglia

• reward

• cognition

• motor-control

The prefrontal cortex

• executive functioning

• self-regulation

• decision-making

• thinking before acting

• more

The frontal lobe

This is the largest and forward-most part of the brain, most affected by ADHD

• emotions

• thinking

• judgement

• personality

• self-control and -awareness

• muscle control and movements

• memory storage

• more

The hippocampus

• memory-consolidation

• spatial awareness and navigation

• decision-making

• emotional processing

• more

Poor network connections

In cases of ADHD, the connections sending information through the brain do not work optimally. An ADHD brain may become out of sync or overwhelmed when trying to interpret and use incoming information. This overwhelm can make a person seem more impulsive or distracted.

Because of these “major network differences” in people with ADHD, they may struggle with:

• impulsivity

• focus

• planning

• attention

• shifting between tasks

• movement and spatial awareness

Neurotransmitter effectiveness

The brain communicates through a network of brain cells called neurons. Neurons transmit signals by releasing a mixture of chemicals that help or hinder neighbouring neurontransmitters to send electrical signals. Dopamine, norepinephrine and serotonin are the neurotransmitters most commonly associated with ADHD.

Brain maturation

Brain development occurs at a slower rate for children with ADHD compared to neurotypical individuals. For some, the brain can sometimes catch up, which leads to a change in ADHD behaviours over time. However, for others, certain parts of the the brain may never reach full maturity, affecting the brain connections and pathways and causing symptoms through adulthood.

ADHD in Children

ADHD looks different from child to child. Knowing which of the three ADHD sub-types your child has is key to developing a treatment plan suited your child.

While all children will show ADHD symptoms from time to time, a child with ADHD will show many symptoms which have a persistent and pervasive impact on two (or more) areas of their lives.

The three ADHD subtypes

1) Inattentive ADHD

Inattentive ADHD is most common in girls and women, and often, they do not see a diagnosis until their late teens or adulthood. Children with the inattentive presentation of ADHD often show some of these symptoms:

• Difficulty listening actively

• Challenges following instructions.

• Easily distracted

• Forgetful

• Struggle to maintain focus during tasks, (especially if the task is uninteresting or requires sustained mental effort)

• Inability to keep track of belongings

• Makes careless errors

• Disorganization

• Problems managing time

2) Hyperactive-Impulsive ADHD

Hyperactive-Impulsive ADHD is most common in boys and men, who often get a childhood diagnosis. Children with the Hyperactive-Impulsive presentation of ADHD often show some of these symptoms:

• Constantly moving or fidgeting

• Difficulty remaining seated when required

• Interrupting others, blurting out answers, inability to await their turn in conversation

• Seem to be “driven by a motor.”

• Excessive talking

• Struggle to engage in tasks quietly

3) Combined ADHD

Children diagnosed with the combined presentation, which is most common, will have presentations of both inattentive and hyperactive ADHD.

ADHD Severity

ADHD is also marked by the severity of symptoms, which can vary throughout life.

Mild ADHD

A person with mild severity ADHD has sufficient symptoms for diagnosis. The symptoms, however, have a relatively small effect on the person’s social, work, and academic life.

Moderate ADHD

Symptoms in moderate severity ADHD cause more functional impairment than with mild severity, but less impairment than severe ADHD.

Severe ADHD

People with severe ADHD show symptoms have significant difficulty engaging in social, academic and professional settings effectively.

Other Symptoms of ADHD in Children

ADHD also has potential to influence a child’s functioning in a variety of areas, including academic settings, family environments, workplaces and in community interactions:

• Emotional and/or behavioural responses that are immature for the child’s age

• Difficulty managing emotions, behaviours and cognitive processes

• Engagement levels, cognitive fatigue, and environmental conditions affecting performance:

  • organization

  • distraction

  • incentives

• Consistent inconsistency

• Challenges performing with tasks they find uninteresting

• Intense focus, or hyper-focus, when engaged in tasks that capture their interest

• Time blindness – a lack of awareness of time passing, particularily in periods of hyper-focus

• Difficulty regulating and shifting attention

  • hard time transitioning from one task to another, particularly from a preferred task to a non-preferred one

• Struggle to interact with peers or establish positive relationships