Neurological Disorders: ADHD (ADD)

ADHD (ADD) abbreviation stands for Attention Deficit Hyperactivity Disorder (or Attention Deficit Disorder). It is considered as a developmental disorder (neurobehavioral type) and this condition is predominantly seen in children.

Neurologist, psychiatrist and counselor (therapist) are the healthcare specialists frequently involved in the management of Attention deficit hyperactivity disorder.

There are mainly two components with this condition; attention & hyperactivity. If only attention problem is seen or predominant then ADD term is preferred, if hyperactivity is also seen then ADHD is preferred.

It is mainly a childhood disorder however it may persist into adulthood. It can affect any race, gender or ethnicity. Boys are affected more than girls.

Attention function is mainly mediated by frontal lobes and their connections with other areas of the brain including thalamus, basal ganglia etc. Frontal lobe also inhibits inappropriate behaviors. The dysfunction in these areas and their connections can result in decreased attention and hyperactivities.

Neurochemicals like dopamine, (nor-epinephrine) nor-adrenaline are implicated in the development of this condition. Their deficiency in the above regions of the brain makes somebody susceptible to develop this condition.

A patient will manifest with either attention deficits, hyperactivity or both.

On the attention side;

• Inability to organize well
• Problem with keep focused (sustained mental activities)
• Inadequate attention is given to details
• Appears not listening properly during conversation
• Doesn’t finish tasks in the absence or arrogance or mental retardation
• Misplacing or losing things that are necessary for daily activities
• Forgetfulness
• Easily getting distracted

On the hyperactivity side;

• “He/she has no patience” type of profile
• Cannot wait for his/her turn
• Fidgety nature
• Cannot remain in the same position for long
• Inappropriate behaviors
• Difficult to remain quite for long
• Appearing impulsive
• Excessive engaging in conversations
• Inappropriate interruption of other’s activities

The diagnosis of attention deficit hyperactivity disorder is mostly clinical. Patient need to have sufficient number of symptoms (≥ 6) for ≥6 months at least, as per DSM-IV criteria.

If there are doubts about any underlying brain damage then relevant investigations like CT or MRI scan of brain, blood tests, EEG etc may be ordered (decided on case to case basis) but such tests are not necessary with the most of the typical cases.

Mild cases may not require any special treatment except reassurance.

When the manifestations are more than mild then behavioral therapy with or without medications are tried.

Some of the commonly employed medications used for treating ADHD (ADD) condition include 1) Stimulants like ritalin (methylphenidate), amphetamine etc and 2) Non-stimulants like clonidine or guanfacine etc.