Surupa Chakraborty, Amity University Kolkata
“The world is full of endless possibilities to contemplate, and my brain has no idea where to put them all. They just tumble around in there like balls in a lottery machine.”
~As quoted by someone who has been seeking refuge from the nonstop chaos inside his/her ADHD brain.
ADHD? Not me. Not a big deal.
Attention deficit hyperactivity disorder (commonly abbreviated as ADHD or simply ADD) is quite stereotyped and its severity is underestimated. The current estimates as per The Centers for Disease Control and Prevention (CDC) reports are that 11% of the children or more than 1 out of 10 children have ADHD. There has also been a remarkable growth in the number of young adults as well as elderly patients who have met the diagnostic criteria. ADD/ADHD is not just a behavioral problem but has got far more to do with the brain’s management system and its executive functions. Most importantly, it has no relation with one’s intelligence quotient (IQ). One can be anything along the IQ spectrum and still have ADHD. It is a prevalent cognitive and debilitating behavioral disorder categorized under two major persistent domains viz. inattentive and hyperactive and/or impulsive which tend to make more trouble especially as one begins transitioning into adulthood. Despite the prevalent chaos, people with ADHD have a remarkable ability to channelize their energy into creative pursuits and excel at the things they enjoy.
There are three different models which are compared and contrasted because of having markedly different ways of accounting for the key aspects of ADHD. They are:
- Dopamine transfer deficit model of ADHD
- Dynamic developmental theory
- Extended temporal difference (TD) model
For the ease of our understanding, the dynamic developmental-behavioral theory can be taken into consideration. It is based on the hypothesis that altered dopaminergic function leads to inappropriate modulation of non-dopaminergic signal transmission. These non-dopaminergic signals are primarily due to glutamate and gamma-aminobutyric acid (GABA). In addition, a hypo functioning mesolimbic dopamine branch accounts for the altered reinforcement of behavior and further gives rise to delay aversion and development of deficient sustained attention hyperactivity and/or impulsiveness in ADHD. It is believed that lower levels of dopamine (a neurotransmitter released when the brain is expecting a reward, taking a risk, being impulsive, etc) and norepinephrine (a neurotransmitter involved in attention and arousal) contributes to the symptoms of ADHD. Several diagnostic studies have highlighted that genetic factors, heredity, and environmental factors can also serve as interesting clues in understanding the etiology and likelihood of ADHD.
Symptoms of ADHD
Various symptoms of ADHD are listed below through a pictorial representation:
The above figure shows a diagrammatic representation of the dynamic developmental-behavioral theory of ADHD, along with the usual symptoms of ADHD.
ADHD and medication: a very complex scenario
The treatment options may vary from one person to another, depending on the symptoms shown. Some might have problems related to concentration and organization apart from the usual primary symptoms identified by the National Institute of Mental Health (NIMH). Some patients might display overlapping symptoms including depression, anxiety, and personality disorders. Most often, the treatments target decreasing distractions, improving time management and organizational skills involve cognitive behavioral therapy (CBT) or behavioral psychotherapy, medication, or both. Evidence-based studies also suggest that mindfulness-based meditation programs can help people dealing with preliminary ADHD, to manage their symptoms. Unfortunately, there is no ideal paradigm for the treatment so, the road off of an ADHD medication is likely to be a bumpy one. First-line medications or stimulants like methamphetamine, dextroamphetamine, methylphenidate, etc. are prescribed to increase or normalize the levels of neurotransmitters released between the neurons, thereby reducing the symptoms.
Non-pharmacological interventions: a quick fix
ADHD experts all over the world discuss natural remedies as alternative complementary treatments covering the known efficacies of aerobic exercises, meditation, yoga, and diet rich in omega 3’s (for improved concentration), zinc (to treat impulsivity), iron (for improved behavior) and magnesium (for calm and emotional stability). Going off medications can be enticing for many, especially for those who have been on them for years, however, these treatment procedures should be held to the same rigor of repeatable evidence-based results before being recommended. It is also noteworthy to mention that new non-pharmaceutical methods are currently being tested by Dr. Julie Schweitzer and her team, using computer brain training for relieving specific symptoms of ADHD.
Further research is needed to delve deeper and elucidate the pathophysiological mechanisms of ADHD, and the therapeutic actions of different medications as well as non-pharmacological training methods in future interest of neuroscience findings. Integration of such findings along with studies of genetic association, toxin exposure, and genetic-environmental interactions is also required to trace their accurate relevance in altering functionality within the brain, thereby giving rise to different symptoms.
Impact of Covid-19 with special reference to ADHD
ADHD shows high comorbidity with other neurological disorders including autism spectrum disorder (ASD), motor disorders, reading disability, developmental coordination disorder, intellectual disability, behavioral problems including conduct disorders, and oppositional defiant. Despite its high prevalence and significant impact on mental health and daily life, people diagnosed with ADHD have experienced delays in regular assessment, physical monitoring, initiation of medication, and treatments. ADHD experts and medical teams are struggling to keep up with the growing demand of ADHD patients, especially during the ongoing pandemic. This increased irritability, oppositionality, and behavioral challenges among young people battling with ADHD and comorbid ASD. However, telepsychiatry (psychiatric interventions including pharmacotherapy, behavior therapy, and psychotherapy) aided to the respite in some patients with a wide range of conditions, in personal settings including home primary care as well as in schools. With ongoing pandemic restrictions over the months along with a parallel epidemic of anxiety, impulsiveness, and depression, there is an urgent need to check for the symptoms and find effective practical treatment approaches (like telepsychiatry, telemedicine, etc.) in assessing and treating young adults with ADHD, ignorance of which can only augment the already existing health disparities.
Also read: Drug development from traditional to recent methods
Reference:
- Antrop, I., Stock, P., Verté, S., Wiersema, J. R., Baeyens, D., & Roeyers, H. (2006). ADHD and delay aversion: the influence of non-temporal stimulation on choice for delayed rewards. Journal of child psychology and psychiatry, and allied disciplines, 47(11), 1152–1158. https://doi.org/10.1111/j.1469-7610.2006.01619.x
- Tripp, G., & Wickens, J. R. (2009). Neurobiology of ADHD. Neuropharmacology, 57(7-8), 579–589. https://doi.org/10.1016/j.neuropharm.2009.07.026
- Beauchaine, T. P., Ben-David, I., & Sela, A. (2017). Attention-deficit/hyperactivity disorder, delay discounting, and risky financial behaviors: A preliminary analysis of self-report data. PloS one, 12(5), e0176933. https://doi.org/10.1371/journal.pone.0176933
- McGrath J. (2020). ADHD and Covid-19: current roadblocks and future opportunities. Irish Journal of psychological medicine, 37(3), 204–211. https://doi.org/10.1017/ipm.2020.53
- Spencer, T., Noyes, E., & Biederman, J. (2020). Telemedicine in the Management of ADHD: Literature Review of Telemedicine in ADHD. Journal of attention disorders, 24(1), 3–9. https://doi.org/10.1177/1087054719859081
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