Attention deficit hyperactivity disorder (ADHD)

ADHD can be influenced by a combination of personal, familial, and social factors, much like other mental health conditions. The following risk factors are associated with ADHD:

Age

• Children between the ages of 3 and 12 years are more susceptible to ADHD. In India, approximately 7% of school-aged children are diagnosed with the condition.

Family History

• Children with siblings who have ADHD are at a higher risk. Family studies show a 2- to 8-fold increase in the likelihood of ADHD in parents and siblings of affected children. Additionally, twins are more likely to both have ADHD than children born as singletons.

Factors Affecting Expectant Mothers

Children whose mothers are exposed to certain substances or conditions during pregnancy are at an increased risk of developing ADHD. These include:

• Lead
• Cigarette smoke
• Alcohol
• Medications such as corticosteroids and antidepressants
• Certain food additives

Expectant mothers facing the following conditions are also more likely to have children with ADHD:

• High levels of stress
• Mental health conditions
• High blood pressure
• Hyperthyroidism

Premature Birth

• Babies born prematurely (before 37 weeks of gestation) have a greater chance of developing ADHD later in life.

Low Birth Weight

• Research indicates that children born with a lower birth weight are more likely to develop ADHD as their nervous system may not have developed optimally.

Neonatal Conditions

Children born with certain medical conditions are more prone to ADHD, including:

• Hypoglycemia
• Kidney issues
• Liver diseases
• HIV/AIDS

Medical Conditions

Individuals with certain health conditions are more likely to develop ADHD, such as:

• Seizures
• Asthma
• Gastrointestinal disorders, like celiac disease and gluten sensitivity

ADHD is diagnosed through the following steps:

Excluding Other Conditions

ADHD shares symptoms with various other learning disabilities and mental health disorders, including:

• Depression
• Bipolar disorder
• Anxiety
• Obsessive-compulsive disorder

Therefore, it’s important to rule out these conditions using laboratory tests and imaging, such as X-rays or brain scans. Sometimes, symptoms might be caused by side effects from medications, which can be identified through blood tests.

Clinical Evaluation

There are no specific tests to diagnose ADHD. Diagnosis is based on observed symptoms. Healthcare providers follow the guidelines set by the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5) to ensure a standardized approach. The DSM-5 lists symptoms related to inattention and hyperactivity/impulsivity.

For ADHD to be confirmed:

• Children up to 16 years old must show at least 6 symptoms.
• Individuals 17 years and older need at least 5 symptoms.
• Symptoms must appear in more than one environment (e.g., at home, school, or work).
• Symptoms should significantly impair social, academic, and occupational functioning.

Quick tip!

Younger children in the same class may sometimes be incorrectly diagnosed with ADHD, as small age differences can affect their ability to focus and behave appropriately.

DSM-5 Symptoms List:

Inattention Symptoms:

• Making careless mistakes
• Difficulty focusing on tasks
• Not listening when spoken to directly
• Failing to follow instructions
• Struggling to organize tasks
• Avoiding tasks that require mental effort
• Frequently losing items needed for activities (e.g., books, keys, school materials)
• Easily distracted
• Forgetting simple tasks

Hyperactivity/Impulsivity Symptoms:

• Constant movement
• Leaving the seat when expected to stay seated
• Running or climbing in inappropriate situations
• Difficulty playing quietly
• Acting as if constantly “on the go”
• Excessive talking
• Interrupting others or blurting out answers before questions are finished
• Trouble waiting for their turn

Note: This symptom list is for informational purposes only. A trained healthcare provider should conduct a thorough evaluation to diagnose ADHD.

While ADHD cannot be fully prevented, certain strategies may help reduce the risk:

Exercise Caution During Pregnancy

Exposure to certain substances and medications during pregnancy can increase the risk of ADHD in the developing child. Pregnant women should avoid:

• Smoking
• Alcohol
• Contaminants like lead and polychlorinated biphenyls (PCBs)
• Medications, such as corticosteroids and antihypertensives, which may raise the risk of ADHD

Consulting with a doctor before taking any medications during pregnancy is advised.

Shield Your Child from Toxins

Children should be protected from environmental pollutants and toxins that can contribute to the development of ADHD. Specific toxins to avoid include:

• Cigarette smoke
• Industrial or agricultural chemicals
• Lead paint (found in older buildings)

Limit Screen Time

Although there is no definitive evidence, it may be beneficial to limit screen time, such as TV and video games, especially in the first five years of a child's life.

In addition, implementing these practices can help reduce complications for children with ADHD:

• Establish a structured daily routine, including set times for waking up, meals, reading, and play
• Provide undivided attention when giving instructions to your child
• Communicate regularly with your child's teachers and caregivers to monitor their behavior and progress

Specialists to Consult

An integrated healthcare plan is essential for effectively diagnosing and managing ADHD. Various specialists can contribute to treatment and care, including:

• General Physician: Helps assess symptoms and diagnose ADHD, and can refer patients to specialists for further evaluation.
• Psychiatrist: Confirms the diagnosis of ADHD through psychological assessments and testing.
• Pediatrician: Manages the diagnosis and treatment of ADHD in children.
• Physical Therapist: Designs activities to improve motor skills, strength, posture, and balance.
• Behavioral Therapist: Teaches social skills and helps children develop appropriate behaviors, such as conversational skills.
• Counselor: Supports self-acceptance and helps reduce anxiety associated with ADHD.

Proper diagnosis and treatment can significantly enhance the quality of life for individuals with ADHD. The treatment approach varies depending on the age of the person and includes:

A. Behavioral Therapy

Behavioral therapy is the primary treatment for children under the age of six. For children over six years old, a combination of medication and behavioral therapy is often recommended.

Behavior therapy focuses on reinforcing positive behaviors and addressing negative or problematic ones. It is beneficial to begin this therapy as soon as the diagnosis is made.

Key components of behavioral therapy include:

• Parent training
• Direct therapy with children
• Behavioral strategies in the classroom
• Peer interventions
• Organizational skills training

B. Medications

Medications play an important role in managing ADHD symptoms in daily life. These include:

1. Stimulants: These are the most commonly used drugs for treating ADHD. Examples include amphetamines and methylphenidates.
2. Nonstimulants: For children who do not respond well to stimulants or experience anxiety, nonstimulant medications may be prescribed. These include:

• Antidepressants (such as Atomoxetine and Bupropion)
• Alpha agonists (Clonidine and Guanfacine)

Quick Tip!

A technique known as trigeminal nerve stimulation has shown promise in treating ADHD. This method involves a device that delivers mild stimulation to the trigeminal nerve, helping to reduce hyperactivity.

ADHD can lead to several complications, including:

• Academic struggles and failure
• Accidents resulting from impulsivity and the constant need for movement
• Low self-confidence
• Increased risk of substance abuse (alcohol and drugs)
• Learning disabilities
• Mental health conditions like depression and anxiety
• Oppositional defiant disorder (characterized by frequent anger and defiant behavior)
• Mania
• Tourette syndrome (characterized by involuntary movements or vocalizations)

In addition to conventional treatments, the following therapies may help alleviate ADHD symptoms:

Calming Techniques

These techniques aim to enhance mental well-being and reduce symptoms. Effective calming methods include:

• Mindfulness meditation
• Breathing exercises
• Journaling for emotional health
• Yoga or Tai Chi
• Regular meditation and yoga practices have been shown to improve anxiety, hyperactivity, and social difficulties.

Cognitive Behavioral Therapy (CBT)

CBT is a therapeutic approach that focuses on altering negative thought patterns. It helps individuals with ADHD manage challenges by fostering better coping mechanisms and enhancing control over their behaviors.

Self-Massage

Massaging areas like the neck, scalp, and behind the ears can be a soothing practice. This relaxation technique is associated with a reduction in ADHD symptoms, especially when practiced after a stressful day.

Family and Marital Therapy

This therapy helps families manage disruptive behaviors and improve communication. It encourages behavioral changes and strengthens relationships with individuals who have ADHD.

Parenting Skills Training

This program teaches parents how to reinforce positive behaviors in their children. It focuses on using a system of rewards and consequences to guide behavior modification.

Here are some important steps for managing ADHD at home:

A. Adjust the Diet

While diet isn't a direct treatment for ADHD, eating a balanced and nutritious diet can support overall health. Consider incorporating the following foods into your daily meals:

1. Apples: Apples are a good source of complex carbohydrates, which may help regulate sleep patterns in people with ADHD. Pears can be a suitable alternative. Consuming these before bedtime can promote better sleep.
2. Fatty Fish: Omega-3 fatty acids, found in cold-water fatty fish like salmon, mackerel, tuna, herring, and sardines, are beneficial in managing ADHD symptoms. These can be added to wraps, salads, pasta, and sandwiches.
3. Nuts: Walnuts, almonds, and cashews are rich in omega-3 fatty acids, vitamins, and minerals, making them a great addition to the diet.
4. Leafy Greens: Vegetables like spinach are important for ADHD sufferers. Spinach can be cooked or blended into smoothies with fruits like berries.
5. Oranges: Oranges, rich in vitamin C, can help improve sleep quality. They can be eaten fresh, added to fruit salads, or consumed as juice.

Quick Tip!

Foods high in protein, such as poultry, fish, eggs, beans, nuts, soy, and low-fat dairy, can be particularly beneficial for ADHD symptoms. Protein helps in releasing chemicals that facilitate communication between brain cells and prevents blood sugar spikes, which can reduce hyperactivity.

Avoid Certain Foods

Certain additives, such as sodium benzoate, artificial food colorings, and preservatives, can worsen ADHD symptoms. Foods containing these ingredients should be limited or avoided, including:

• Soft drinks
• Ice creams
• Candy
• Pickles
• Fruit juices
• Salad dressings
• Icing
• Carbonated beverages
• Breadcrumbs

B. Exercise Regularly

Regular physical activity is known to help reduce ADHD symptoms. Consider incorporating the following exercises:

• Running
• Walking briskly
• Cycling
• Swimming laps
• Dancing
• Gymnastics
• Yoga
• Strength training (squats, push-ups, pull-ups, weightlifting)

Before starting any new exercise program, it's important to consult with your doctor to ensure the activities are suitable for your age and health condition.

C. Stick to a Sleep Routine

Sleep issues are common among individuals with ADHD. The following tips can help improve sleep quality:

• Follow a consistent sleep schedule to regulate your internal clock.
• Limit screen time before bed.
• Avoid caffeine (tea, coffee) late in the evening.
• Have a light dinner to prevent discomfort that may affect sleep.
• Engage in physical activity during the day, but try to finish workouts at least two hours before bedtime.

Managing life with attention deficit hyperactivity disorder (ADHD) can be difficult due to the challenges it presents in daily activities. The symptoms can make routine tasks feel overwhelming and stressful. It is important to seek support and understand how to manage the condition effectively.

Here are a few strategies to improve daily life and enhance overall well-being:

Educate Yourself

It’s crucial for individuals with ADHD and the parents of children with ADHD to learn more about the condition. Understanding the symptoms and treatment options can greatly assist in managing the disorder.

Maintain Communication with Healthcare Providers

Staying in regular contact with healthcare professionals is essential for both patients and their families. Open and ongoing communication allows for monitoring progress and adjustments to treatment plans. Consistent follow-ups are also important to address any related conditions, such as depression, and ensure the treatment is effective.

Avoid Triggers and Allergens

Certain allergens may exacerbate ADHD symptoms in some individuals. Identifying and avoiding potential allergens through diet and lifestyle changes can help improve behavior.

Spend Time Outdoors

Research has shown that spending time outdoors, especially in natural environments, can positively influence behavior. A brief walk in a green space—just 20 minutes—can help boost health and improve mental well-being.

Parenting Tips

Parents can use the following approaches to support their children with ADHD and enhance their overall functioning:

• Administer medication as prescribed and store it safely away from children.
• Have open, supportive conversations about ADHD with your child.
• Stay informed on the latest research, treatments, and support options by engaging with online communities and medical professionals.
• Focus on your child's strengths and positive qualities.
• Help your child stay organized by encouraging them to keep their belongings in order.
• Limit screen time to reduce distractions.
• Simplify complex tasks by breaking them down into smaller, manageable steps.
• Use goals, praise, or rewards to keep your child motivated.
• Practice positive discipline techniques, such as polite directions, instead of yelling or punishing.
• Ensure your child follows a healthy lifestyle, including proper nutrition, physical activity, and sufficient sleep.

Workplace Tips for Adults

Adults with ADHD may experience difficulties with communication, distractibility, procrastination, and managing complex tasks. The following strategies can help address these challenges:

• Reduce distractions by using "white noise" earphones, working in quiet spaces, taking notes, and focusing on one task at a time.
• Manage impulsivity through self-talk, working with a coach, seeking regular feedback, and practicing relaxation techniques.
• Take breaks throughout the day, jot down key points during meetings, move around, or go for a walk to recharge.