Attention Deficit Hyperactivity Disorder (ADHD)

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This tip sheet on ADHD was prepared by clinical psychologist Arisja Oberholzer.

ADHD has been a diagnosis that many parents have struggled with over the years. This is partly because of the different views of why a child has developed ADHD. This is slowly changing as science is helping us understand how ADHD develops. It is very important to note that ADHD is not a “bad” diagnosis; it simply helps to understand how one’s brain works differently from others. It can be a great asset in many settings with the right support and understanding.

ADHD

What is ADHD?

ADHD has recently been categorised as a neurodevelopmental disorder. It affects people’s ability to self-regulate their emotions. Those with ADHD generally have a deficit in their arousal system, have difficulty inhibiting their responses to situations, and struggle to be motivated.

ADHD symptoms include distractibility, inability to sit and concentrate for an extended period of time, being easily bored with topics that they either struggle with or have no interest in, regular fidgeting, and difficulty keeping hands, feet or body still. Children with ADHD will often leave their seats in situations where it is expected that they stay seated. Their immediate recall of information can be impacted, sleep can be affected, and their ability to organise an activity and finish projects can be reduced. They are more likely to finish other people’s sentences and interrupt others while they are talking. They may struggle to wait their turn.

In simple words, people with ADHD struggle to stop and think before they do something. Their ability to activate their impulse control is not fully developed, so they will do things without thought and only afterwards think of what they had done. This affects social interactions and might lead to social isolation in some cases as other children or adults might not understand why they can’t regulate their thoughts and responses in these situations. This can lead to a decrease in self-worth, and they can start to develop a negative sense of self.

It is really important to understand that someone with ADHD does not always intentionally do things that might harm themselves or others, as they are unable to stop and think in the moment. They will normally show remorse after the fact and this might lead to them talking harshly to themselves. In later years if a child or adolescent had not been diagnosed they can develop negative coping strategies for their inability to stop. They can start lying as they don’t want to get in trouble and won’t be able to explain their actions to others, especially if they felt others expected them to be able to make better decisions.

How does ADHD develop?

There are many theories about how ADHD develops. From the literature, one can conclude that there are multiple factors that influence the development of ADHD.

  • Genetics
    • More likely to develop ADHD if there are other family members with ADHD traits
  • Environment: family influences, stress during pregnancy, stress during birth (more than usual), early development
  • Lack of dopamine and noradrenaline production

 

It is really important to understand that although there is a strong genetic link with ADHD other environmental factors play a role in the expression of these genetics. The environment and other neurobiological factors can also affect the level of ADHD that is expressed.

This is why a very in-depth history is needed before a diagnosis is made. This will also affect treatment models that will best work.

Treatment

The level of treatment would depend on the impact that the ADHD symptoms have on day-to-day functioning. Research has also suggested that a combination of interventions is recommended.

  • Psychosocial interventions
    • Behaviour modification using reward systems and good modelling
  • Family Therapy (for ADHD children)
    • To help families understand each other better, changing interactions in the family home, modelling, recognising that many factors might be affecting the child as well as the family
    • Creating routine and structure in the house
  • Cognitive Behaviour Therapy to help develop a healthier sense of self
  • Play therapy for children
    • Helping develop emotional regulation through breathing exercises, relaxation and sensory soothing techniques
    • Exploring strengths
    • Focusing on the benefits of ADHD such as energy, ability to hyper-focus on things they enjoy, having a big-picture view
  • Psychoeducation
  • Occupational Therapy
    • Many children with ADHD have other developmental areas, perhaps including learning difficulties, which might contribute to some of their behaviours. It can help to support them on a number of levels.
  • Pharmacology
    • Stimulant medication has shown to help activate the regions in the brain that are under active
  • Nutrition
    • A healthy diet helps the brain to form better pathways
    • Breakfast is extremely important, including having some protein, which helps develop new brain cells
    • Refined sugar negatively affects the brain’s capacity to focus. It might not cause hyperactivity, but negatively impacts on areas of the brain that help us concentrate and focus. This negatively affects the ability to remember
    • Regular intake of food might be required
    • Some children react to gluten. This can be discussed with a nutritionist
  • Supplements/Vitamins and Minerals
    • Magnesium (Mg)
      • Also helps with growing pains and cramps
      • Important in neural connections
    • Iron (if deficient)
    • Zink (Zn)
    • Omega 3
    • B Vitamins
    • Chromium
    • Oligomeric Proanthocyanidins (OPCs)
      • Found in pine tea, peanut skin, blueberries, cranberries, dark chocolate, grapeseed, ginkgo biloba and pine bark
    • Neurofeedback
      • This has shown great results as it helps the brain learn how to switch on connections.

What you can do at home

If you or a loved one has ADHD, it is important to understand that this is not a disability. It means that your brain works slightly differently for various reasons.

Create a routine that is easy to follow. This can be done with a picture chart for younger children. For older children and adults it can be written out, laminated, and then each step can be ticked off as they complete their routine.

Changes in routine and schedules should be communicated at least 24 hours ahead of time if possible to give them enough time to process what will be expected in their management of time. Predictability helps them cope better so that they are more likely to follow social convention.

If it is an adolescent, young adult or even an older adult do not worry! Many ADHD individuals develop strategies to help them and are able to get on with life, showing amazing talents. They are normally quite clever in all kinds of ways and just need a bit of support with organisation and motivation. Their relative lack of dopamine makes it really hard for them to get motivated to start, their brain is so full of ideas and thoughts that it is hard to concentrate enough to organise things. It greatly helps if there is someone that they trust who can help develop some systems for them. This helps with their organisation and will help to motivate them further. They might also need someone to help them with final touches to a project.

Related Articles

The Benefits of Recognising ADHD (article)

The Benefits of ADHD (video)

Healthy Minds (Geelong Advertiser Article about ADHD)

Tips for Focussing Attention (vide0)