Attention deficit hyperactivity disorder

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder that begins in childhood and can persist into adulthood. It is defined by patterns of inattention, hyperactivity, and impulsivity, which disrupt learning, relationships, and daily functioning. Although frequently diagnosed in children, ADHD is increasingly recognised in adults, where it may present differently and often goes underdiagnosed.

⚡ Core Symptoms

• 🔎 Inattention: Difficulty focusing, disorganization, forgetfulness, distractibility, careless mistakes.
• 🏃 Hyperactivity: Restlessness, fidgeting, excessive talking, inability to stay seated, difficulty with quiet play.
• ⚡ Impulsivity: Interrupting conversations, blurting answers, acting without thinking, difficulty waiting turns.

📑 Types of ADHD (DSM-5)

• 📝 Predominantly Inattentive: Main difficulty is sustaining focus (often seen in girls, may be missed at school).
• 🔥 Predominantly Hyperactive-Impulsive: Main difficulty is overactivity and impulsive behaviours.
• ⚖️ Combined Presentation: Both domains are significantly impaired — most common in clinical practice.

🩺 Diagnosis

Diagnosis is clinical, based on detailed history, observation, and DSM-5 criteria. No single test confirms ADHD.

• 📚 History: Input from parents, teachers, or workplace reports across multiple settings.
• ⏳ Symptom Duration: Present for ≥6 months and onset before age 12.
• 🛑 Impairment: Must cause functional impairment (academic, social, or occupational).
• 🧾 Tools: Conners’ Rating Scales, ADHD Rating Scale, SNAP-IV.

🤝 Associated Conditions

ADHD often coexists with other neurodevelopmental or psychiatric conditions:

• 😡 Oppositional Defiant Disorder (ODD): Defiant, hostile behaviour.
• 📘 Learning Difficulties: Dyslexia, dyscalculia, impaired working memory.
• 😰 Anxiety Disorders: Generalised or social anxiety common.
• 😔 Depression: Especially in adolescents/adults with long-term academic/social struggles.
• 🍷 Substance Use: Higher rates in teens/adults with untreated ADHD.

💊 Pharmacological Management

Medication is the mainstay in moderate–severe ADHD. It improves focus, impulse control, and behaviour.

• 🚀 Stimulants:
  • Methylphenidate (Ritalin, Concerta): ↑ dopamine/noradrenaline, first-line in UK NICE guidance.
  • Dexamfetamine / Lisdexamfetamine: Alternative stimulant; useful if methylphenidate ineffective.
• 🌿 Non-Stimulants:
  • Atomoxetine: Selective noradrenaline reuptake inhibitor; preferred in cases of substance misuse risk.
  • Guanfacine, Clonidine: Alpha-2 agonists; helpful for hyperactivity, impulsivity, sleep disturbance.

🧩 Behavioral & Psychological Therapies

• 👨‍👩‍👧 Parent Training: Behaviour management, consistent routines, positive reinforcement.
• 🧠 Cognitive Behavioural Therapy (CBT): Helps older children/adults manage organisation, impulsivity, and emotional regulation.
• 🏫 School Support: Individual Education Plans (IEPs), classroom adjustments, smaller tasks with frequent breaks.

🏃 Lifestyle Modifications

• 💪 Exercise: Improves mood, focus, and reduces hyperactivity.
• 🥦 Diet: Balanced diet; limit sugar and additives (evidence modest but may help some).
• 🛏️ Sleep Hygiene: Consistent bedtime; avoid screens late at night.

📈 Prognosis

ADHD often persists into adulthood (~60%). Many adapt successfully with treatment, though challenges in education, work, and relationships may remain. Early recognition + multidisciplinary support = best outcomes.

✅ Conclusion

ADHD is a common and impactful condition. Management requires a holistic approach combining medication 💊, behavioural therapy 🧠, and lifestyle optimisation 🏃. With early diagnosis, patient/family education, and long-term support, individuals with ADHD can thrive academically, socially, and professionally.