Daily Times

Attention deficit hyperactivity disorder (ADHD) is not the latest trend.

It is not a deficit in attention.

It is not a pharmaceutical-made diagnosis.

It is not acquired overnight or over a pandemic.

It is not a result of excessive internet use.

It is not a learning disability.

It is not a lack of discipline.

It is not a lack of faith.

It is not a diagnosis of rich.

It is not an urban diagnosis.

It is not a sign of low intelligence.

ADHD is a neurodevelopmental disability that affects the executive processes of the brain; it is different from energetic socialisation behaviour. The American Psychiatric Association (APA) publicly recognised ADHD as a diagnostic entity as a hyperkinetic impulsive disorder in the late 1960s. Interestingly, the FDA first approved psychostimulant medication in 1955.

ADHD cases began to rise significantly in the 1990s. As the number of ADHD cases increased, newer medications became available. Factors underlying the spike in ADHD cases include more doctors trained to diagnose the condition effectively, parents being aware and reporting children’s symptoms, and more people developing it.

The condition has evolved as experts have learnt more about science. Nevertheless, the fundamental indicators remain the same as British paediatricians George Frederic described in 1902. He discovered that some children could not control their behaviour the same way other children could; nonetheless, they were intelligent. Therefore, it is not a sign of low intelligence. There is no coherent connection between ADHD and IQ. However, both children and adults, with exceptionally high IQs, can struggle with ADHD symptoms. In addition, high-IQ people may be able to mask or compensate for signs that may lead to delays in diagnosis and treatment.

ADHD does not discriminate against anyone. It is a common disorder that affects people of all ages, genders, IQ levels, races, religions, and socioeconomic backgrounds. Research shows a solid hereditary link between ADHD and family history. The causes of ADHD may include a combination of genetic (hereditary) and neurological factors (pregnancy and birth problems, brain damage, poisons, and infections) rather than social factors, such as ineffective parenting. Inconsistent parental discipline and inadequate father participation may impact ADHD symptoms manifestation but not cause it. Although parenting practices do not cause the condition, they can worsen coexisting disorders like oppositional defiant disorder (ODD) and conduct disorder (CD).

The American Psychiatric Association publicly recognised ADHD as a diagnostic entity (hyperkinetic impulsive disorder) in the late 1960s.

While research on ADHD diets has yielded conflicting findings, some experts believe that dietary adjustments benefit the brain’s attention function. There is, however, no evidence that sugar consumption causes ADHD. Although the impact of preservatives and food additives is unknown, the American Academy of Paediatrics believes it is advisable to avoid these compounds for assorted reasons. For instance, high protein may help concentration. Replacing simple carbs with refined carbohydrates may be beneficial

A family history of ADHD and any comorbid illnesses in childhood are strong indications of the disorder’s persistence in adults. ADHD is a serious condition, mainly, if it stays undiagnosed and untreated, which may pose cumulative risks throughout life. In children, the inability to concentrate leads to inadequate academic performance and difficulties in establishing friendships. Adults struggle at work with lower productivity and are more likely to use substances or alcohol. They wrestle with organisation, starting new projects and quitting midway, emotional instability, disregard for one’s and others’ safety, a negative self-image, and a lack of drive.

The estimated prevalence in Pakistan is around 2.5 per cent. The gender ratio is 4:1. Although females have a more inattentive type, males exhibit a more hyperactive-impulsive type. As a result, guys are diagnosed with ADHD twice as girls. Approximately 70 per cent of children diagnosed display symptoms in their late teens or adulthood. The intensity of expression varies widely and depends upon the individual’s developmental age, degree of brain alterations, associated conditions, environment, and response to that environment. A concurrent anxiety disorder affects up to 30 per cent of children and 40 per cent of adults with ADHD. Furthermore, 50 per cent of people have a coexisting learning disability, often language based. 70 per cent of people seek depression treatment at some point.

ADHD is more than a lack of focus. It is a problem with working memory, self-regulation and executive functions. Persistence toward a goal entails behaviour, motivation, and foreseeing the future. Unfortunately, people with ADHD are more prone to be time-blind; lacking a focus on future events and planning. As a result, it is less likely to resist distractions and has difficulty returning to work. Most of us can regain our focus back to the original task after being distracted. This ability to re-focus on the task requires the use of working memory. Working memory is where we recollect what we are doing-remembering to do it consciously, with effort, and with keeping the information in mind. As a result, they frequently lose interest in repetitive or predictable tasks. They can, however, pay close attention to stimulating activities. When completely immersed in a new or challenging task, they may lose track of time, known as hyperfocus.

For ADHD diagnosis, symptoms must be present at an early age, for more than six months, and occur in more than one setting. ADHD makes up 30-40 per cent of referrals to child psychiatrists. With less than ten child psychiatrists in the country, most of these children present to paediatricians, GPS or adult psychiatrists. Unfortunately, they receive limited or no child psychiatry training. Only 13.7 per cent GPs and 21.6 per cent of paediatricians have shown sufficient knowledge to screen or diagnose ADHD effectively.

Undoubtedly, the number of prescriptions has risen dramatically for children worldwide, with recent and similar patterns reported in adults. However, this trend has sparked anxiety and fears that children are being over-treated. There is criticism for doctors in medicalising day-to-day behaviour. Many factors, including lack of training, society’s awareness, healthcare culture, and social context-including historical, cultural, and economic reasons-limit the doctor’s therapeutic choice. This miscalculation stems from a standard error: confusing correlation with causation. It is undeniably true that teenagers who have ADHD are more likely to abuse substances compared to their neurotypical peers. This impact, though, is not a result of medication use. The contrary is true. Untreated ADHD increases the risk of substance abuse, although proper treatment lowers the risk.

ADHD does not mean seeking attention. It is about trouble managing attention rather than pursuing it. On the contrary, most persons with ADHD dislike being in the spotlight. One of the most damaging outcomes is the inability to form and maintain peer connections. By second grade, 50 to 70 per cent of children with ADHD have lost close friendships. As a result, by adulthood, there is constant self-criticism, social anxiety, and conflicting self-esteem. ADHD is sometimes considered a behavioural issue caused by inadequate parenting. It is, however, one of the most heritable conditions. Executive functions and ADHD genes run in families, just like other characteristics that run in families (being a good athlete or having a musical ear or height). Our ability to self-regulate is a neurogenetic characteristic, not a socially learnt behaviour and is determined by our parents.

Many assume that ADHD is an academic diagnosis because it impacts academic achievement. Thus, it is not an educational finding. However, special accommodations, such as additional time on tests, level the playing field, allowing children with ADHD to study just as effectively as their neurotypical peers.

Children with ADHD have 2.2 to 2.5 years less schooling than their classmates on average. They often lose belongings and school supplies that require replacement. They miss lessons and activities after parents have already paid fees or purchased equipment. Likewise, teenagers have a higher rate of getting into automobile accidents, resulting in out-of-pocket costs due to damaged vehicles and fines. One-quarter of these students drop out of high school. In addition, a child hears 20,000 more corrective or critical remarks by their teachers than their neurotypical peers by age 12.

While the debate about the legitimacy of ADHD diagnoses and whether medications are overused or even underused persists, the priority should be promoting optimal evidence-based treatment plans. Meanwhile, specialists should work to recommend and place forward reform measures to support rights and processes for diverse learners’ needs at a broader systems level.

The writer is a Consultant Child, Adolescent and Adult Psychiatrist.