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ADHD

 

 

ADHD is a neuropsychiatric disorder that results in impaired ability to concentrate, impulse control and regulation of activity. If you or someone you know have ADHD there are ways to get help. In this article you can learn about ADHD, and some of the options to get help.

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ADHD stands for attention deficit / hyperactivity disorder and is taken from the DSM diagnostic system [DSM-5][1] . In the ICD diagnostic system, the condition is called hyperkinetic disorder [ICD-10][2] . For the sake of simplicity, we use the term ADHD here.

ADHD is a neuropsychiatric developmental disorder that is characterized by disorders related to regulation of concentration, attention, activity level, impulse control, and which also has a lot to say for the regulation of motivation and emotions. 

ADHD is characterized by a high level of activity (hyperactivity), impulsive (ill-considered) actions and difficulties with concentration and attention, seen in relation to what is expected based on age and situation. A subgroup of ADHD has little, or only mild, degree of hyperactivity and impulsivity, but significant difficulty concentrating and paying attention.

The symptoms must have appeared before the start of school, and lasted over time (more than 6 months). They should be able to be seen in different contexts. The difficulties must also be of such a nature that they have led to a disability in the individual in order for a diagnosis to be made.

The diagnosis is usually made in the specialist health service. Often there are additional difficulties such as behavioral problems, emotional problems, learning difficulties, language deficiencies, motor awkwardness, etc. Other developmental disorders, mental, behavioral or familial difficulties do not rule out ADHD. 

 

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How common is ADHD?

The prevalence among school-age children is estimated to be from 3-5% [Polanczyk et al, 2015][3] . A range of children and adolescents also had ADHD symptoms, however, at a level that do not qualify for a clinical diagnosis. Nevertheless, these symptoms may be related to difficulties at school, at home, and during leisures activities also at subthreshold levels.

Similarly, the prevelance of ADHD among adults is 2.9%, while around 16% of adults has subthreshold ADHD symptoms [Faraone & Biederman, 2005][4] . This means that ADHD symptoms also affect many adults.

 

Symptoms of ADHD

what is adhd

We can divide the symptoms of ADHD into two main areas.

 

Inattention

  • Often fails to be focused on details or makes careless mistakes in school work or in other activities
  • Often has difficulty keeping attention when performing tasks or toys
  • Often do not seem to hear when they are spoken to
  • Often does not follow instructions in full and is unable to finish schoolwork, complete routine work or other tasks
  • Often have difficulty organizing tasks or activities
  • Often avoids or dislikes tasks that require persistent thinking, such as schoolwork or homework
  • Often loses things needed to perform activities, such as books, pencils, toys or tools
  • Often easily distracted
  • Often forget

 

Hyperactivity and impulsivity

  • Often tingles with his hands and feet or twists in the chair
  • Often leaves their desk in the classroom or in other situations where they are expected to sit at the desk
  • Runs or climbs when not needed. Young people may not do that, but they may feel constantly restless
  • Often has trouble playing quietly and calmly
  • Are usually on the go or act as if they were powered by an engine
  • Are often very talkative
  • Often bursts out with the answers before the questions have been completely asked
  • Often have difficulty waiting for their turn
  • Often interrupts or interferes with other people's conversations or games

Source: [NHI, 2020][5]

 

ADHD and self-regulation

ADHD is a complicated disorder. A good post on help by Cecilie Jahreie who focuses on The ADHD brain 5 main challenges point out:

ADHD is perhaps one of the most misunderstood diagnoses we have. It is a developmental disorder that involves a different way of using the brain, and which gives rise to many strengths and many challenges. 

Fortunately, it has been increasingly recognized that ADHD can manifest itself in different ways, and that a prototypical understanding of ADHD as "the hyperactive boy who always disrupts teaching" is not necessarily representative of everyone with ADHD. One perspective that may be helpful is to say that self-regulation is a key to understanding ADHD. Jahreie describes the ADHD condition as follows: 

Having ADHD is like a lamp with a partly destroyed cord, it stands and switches on and off due to a poor power plug.

 

Causes of ADHD

Several large studies have pointed out that heredity plays a significant role in the development of ADHD. The results from the world's largest study about ADHD, where researchers from Bergen were involved, concluded that ADHD is biologically rooted. Jan Haavik at the University of Bergen said:

We show that some people have a higher genetic vulnerability to ADHD (...) and we hope this can change the view of the condition. It's not about bad upbringing or attitudes.

These findings support a previous consensus statement which was given by a number of prominent researchers on ADHD. They emphasize: 

In the media, one can sometimes get the impression that there is deep scientific disagreement about what ADHD is and what causes ADHD. Such a disagreement is not real, according to leading researchers in the field. There is extensive scientific support that ADHD is a real disorder that is primarily due to hereditary conditions, the researchers believe.

As with other complicated conditions, environmental impacts are also important and will affect the prognosis. In addition, difficult living conditions can sometimes be disguised through behaviors and challenges that may be wrongly interpreted as ADHD, something that calls for a nuanced understanding when meeting children and young people who are struggling in their lives.  

 

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Treatment of ADHD

It is well documented that ADHD involves a risk of skewed development. Most people need various interventions over a long period of time, e.g. information, parent counseling, facilitation measures in kindergarten and school and any medication. Individual, family or group therapy may be relevant in relation to additional difficulties. 

It is important that children and young people with various levels of ADHD-related difficulties are detected early so that the necessary interventions can be implemented. This must be combined with a generous concept of normality. The key players in capturing children and young people with difficulties, including ADHD, are parents, the kindergarten / school and the primary health services and the school health service. 

Treatment of ADHD includes a number of measures  [NHI, 2020] :

 

  1. Information about ADHD
  2. Treatment with drugs
  3. Facilitation of conditions at home, at school, at work or elsewhere
  4. Social security benefits
  5. Other social assistance and support measures
  6. Treatment of other concomitant (comorbid) conditions

 

Facilitation for children ADHD

In other words, facilitation measures are an integral part of "treating" ADHD. Some key principles for facilitation for students with ADHD includes:

 

  1. Good understanding of what ADHD entails
  2. Close monitoring
  3. Good classroom management
  4. Good structure
  5. Having few adults to relate to
  6. Always a "plan B"
  7. Visual plans
  8. "Help questions" that sharpen focus
  9. Strengthened parent-school collaboration

Russel Barkley is one of the world's foremost experts on ADHD, and has published a number of studies on ADHD. He emphasizes a number of measures which can help compensate for the difficulties that result from the condition and to prevent additional problems. Below you can see a video of one of his lectures. Alternatively, you can read a summary of his lecture here.

 

  

Help for additional difficulties

Ofte there are additional difficulties (comorbidity) such as behavioral problems, emotional problems, learning difficulties, motor awkwardness, etc. It is not uncommon for parents to struggle in their interaction with the child. Other developmental disorders, mental, behavioral or familial difficulties do not rule out ADHD. As additional difficulties are common in people with ADHD, it must also be emphasized that many children with ADHD need separate interventions that are directed at these additional difficulties.

 

Different forms of help

 

  1. Psychotherapy

     

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    Psychotherapy / treatment is a process characterized by a time-limited contact between a therapist and a patient / client, in which specific problems are thematized and worked with. Include different therapeutic traditions (for example cognitive behavioral therapy (CBT), psychodynamic therapy, family therapy, and more)

    A useful source that evaluate the effectiveness of specific therapies for different mental health problems is the website to the Cochrane Institute [Cochrane Institute][6] .

     

  2. Online therapy

     

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    Online therapy is similar to traditional therapy or treatment, but is provided by digital means (either phone, video conference, or similar). Digital interventions can include a broader range of options, such as therapist-guided self-help programs online.

    The current research literature provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity [Barak et al., 2008][7] .

     

  3. Support / self-help groups

     

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    Support / self-help groups can take a variety of forms, from providing a safe and supportive social environment; more or less structured group meetings; information and guidance relating to how to use available help services; and a lot more.

    While it is difficult to know the effectiveness of such services, due to very different compositions of support and self-help services, the research generally show the self-help groups may have important benefits for the participants [Kurouz et al., 2002][8] .

     

  4. Helplines and chats

     

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    Different helplines and chats exist. Some helplines are specialized in providing you with information and guidance, while others are more specialized in providing emotional support. Some helplines are highly professional, while others are more based on voluntary workers, that merely wish to be a caring listener.

    It is difficult to evalute how effective such services are, and it probably depends on many factors. For example, while the state of the science regarding the effectiveness of crisis response services remains limited, overall results provide support for such services [Hoffberg et al, 2020][9] .

     

  5. Online communities and forums

     

    find-help-mental-health-problems

     

    Online communities and forums are options to get in contact with other individuals that struggle with something similar to you or someone you know. Some communities are moderated by professional health workers, while most of them are not.

    Online communities is traditionally not understood as a support or health service, but rather a social area - that may have the potential of being supportive for the individual that uses it. Importantly, research has shown that "people with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging and by sharing personal stories and strategies for coping with day-to-day challenges of living with a mental illness. Within online communities, individuals with serious mental illness could challenge stigma through personal empowerment and providing hope. By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours" [Naslund et al., 2016][10] .

    This seems to indicate that online communites should not be underevaluated as a potential resource to recovery, coping and enhanced quality of life for people affected by mental health problems.

     

 

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References & Footnotes
  1. DSM-5: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
  2. ICD-10: World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research (Vol. 2). World Health Organization.
  3. Polanczyk et al, 2015: Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual Research Review: A meta‐analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of child psychology and psychiatry56(3), 345-365.
  4. Faraone & Biederman, 2005: Faraone, S. V., & Biederman, J. (2005). What is the prevalence of adult ADHD? Results of a population screen of 966 adults. Journal of attention disorders9(2), 384-391.
  5. NHI, 2020: ADHD. Symptomer og tegn [ADHD. Symptoms and signs]. NHI.no. Retrieved 9th of February 2021 from: https://nhi.no/sykdommer/psykisk-helse/adhd/adhd-symptomer-og-tegn/
  6. Cochrane Institute: Cochrane Institute: "Trusted evidence. Informed decisions. Better health." Retrieved 9th of February 2020 from: https://www.cochrane.org/
  7. Barak et al., 2008: Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N. A. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human services26(2-4), 109-160.
  8. Kurouz et al., 2002: Kyrouz, E. M., Humphreys, K., & Loomis, C. (2002). A review of research on the effectiveness of self-help mutual aid groups. British Journal of Clinical Psychology33, 198-200.
  9. Hoffberg et al, 2020: Hoffberg, A. S., Stearns-Yoder, K. A., & Brenner, L. A. (2020). The effectiveness of crisis line services: A systematic review. Frontiers in public health7, 399.
  10. Naslund et al., 2016: Naslund, J. A., Aschbrenner, K. A., Marsch, L. A., & Bartels, S. J. (2016). The future of mental health care: peer-to-peer support and social media. Epidemiology and psychiatric sciences25(2), 113-122.