ADHD: Etiology, Diagnosis, and Evidence-Based Treatment Approaches

This essay provides a detailed overview of Attention Deficit Hyperactivity Disorder (ADHD). It begins by defining ADHD according to the DSM-5, outlining the key symptoms of inattention, hyperactivity, and impulsivity. The essay then delves into the potential causative and risk factors, including temperamental, environmental, and genetic influences. The diagnostic criteria for ADHD are explained, differentiating between presentations of inattention, hyperactivity/impulsivity, and the combined presentation. The essay further explores treatment options, encompassing both medication and various therapeutic approaches like psychoeducation, behavior therapy, and cognitive behavioral therapy. Finally, the essay surveys current research, highlighting how advancements in brain imaging and neuroscience have improved the understanding of ADHD as a developmental disorder impacting executive functions. The essay includes relevant references to support the information provided.

Running head: ATTENTION DEFICIT AND HYPERACTIVITY DISORDER
ATTENTION DEFICIT AND HYPERACTIVITY DISORDER
Name of the University-
Name of the Student-
Author Note-

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ATTENTION DEFICIT AND HYPERACTIVITY DISORDER
Attention Deficit and Hyperactive Disorder is a very common behavioral disorder in
children. ADHD usually develops during the developmental period, that is, the preschool years;
however the symptoms can be manifested fully or partially, throughout the lifetime. ADHD, as
defined in the Diagnostic and Statistical Manual of Mental Disorders- 5th edition is a disorder in
which individuals show a persistent manifestation of inattention, hyperactivity, and impulsivity
(American Psychiatric Association, 2013).
DSM diagnostic categories-
Symptoms of Inattention are-
 The person makes a lot of mistakes or is unable to give attention to detail.
 They usually find it difficult to sustain their attention in activities.
 They usually seem inattentive even when directly spoken to.
 They usually are unable to abide by instructions and therefore fail to finish the assigned
task in time.
 They often find it very difficult to organize activities and tasks.
 They tend to avoid or dislike tasks that require continuous attention or mental effort.
 Extraneous stimuli can distract them easily.
 They are usually forgetful of daily activities.
Symptoms of hyperactivity and impulsivity are-
 They tend to fidget or tap with their hands or feet or squirm in their seats.
 They tend to leave their seats even in situations where it is expected to be seated.
 They usually run around in inappropriate situations. In case of adolescents, they usually
feel restless.
 They fail to play or enjoy their leisure time quietly.

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 It often seems like they are constantly “driven by a motor”
 They tend to talk excessively.
 They may blurt out answers even before the question is completed.
 They face difficulty in waiting for their turn patiently.
 They tend to intrude or interrupt others frequently.
Causative factors or risk factors for the disorder-
Temperamental factors- Certain temperaments like negative emotionality, effortful
control, reduced inhibition, novelty seeking, are associated with ADHD and these traits in
children might cause a predisposition towards ADHD, however, are not specific to this particular
disorder (American Psychiatric Association, 2013).
Environmental factors-
 Children with low birth weight (lesser than 1.5-kilograms) have a two to three fold
chance of having ADHD, however, most low birth weighted children do not develop
ADHD at all.
 There exist some correlation between ADHD and pregnancy smoking.
 Certain aspects of diet are related to a minor portion of cases.
 Factors like exposure to lead, a history of child abuse, encephalitis, alcohol exposure
while in the uterus, exposure to environmental toxicants while in the uterus, neglect
towards the child, numerous foster placements are correlated to ADHD in children,
however, it is still not known if they are the causal factors or not (American Psychiatric
Association, 2013).
Genetic and physiological factors-

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 Biological first-degree relatives of individuals with ADHD have higher chances of
having the same disorder. However, it is not known if they are the causal factor.
 This disorder is not related to any certain physical feature.
Diagnosis of the Disorder:
 Children are diagnosed with ADHD if they showcase 6 or more of the following
symptoms for at least a period of 6 months to such an extent that their social and
academic activities suffer a negative impact. However, it is to be noted that, these
symptoms are not just the expressions of defiance, oppositional behavior, hostility or
inability to comprehend instructions by the child (American Psychiatric Association,
2013).
 Adolescent children and adults (above 17 years of age) are diagnosed with ADHD when
5 or more symptoms are manifested by them.
 In case of an adult, most of the symptoms must have been present prior to 12 years of
their age.
 The discussed symptoms must be present in at least two different settings, for example, at
home, office, with friends, at work.
 Diagnosis of ADHD requires clear evidence of the fact that interference is caused in the
individual’s social, occupational or academic functioning.
 Diagnosis can only be made if the symptoms do not occur during schizophrenia or other
psychotic disorders and cannot be explained better by any other disorder.
Specification is required whether:
 Combined presentation of inattention and hyperactivity are met for 6 months prior to
diagnosis.

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 Predominant presentation of inattentiveness, that is, symptoms for inattention are met, but
not for hyperactivity.
 Predominant presentation of hyperactivity/impulsiveness, that is, symptoms of
hyperactivity/impulsiveness are met but not for inattention.
Treatment of the disorder-
There are treatments to reduce the ADHD symptoms. Medication, as well as therapy, is
possible but research shows that combination of both gives the best results.
Medication- There are five types of licensed ADHD medications, methylphenidate,
dexamfetamine, lisdexamfetamine, atomoxetine, and guanfacine (Storebø et al., 2015) These,
however, do not cure ADHD permanently but does help relieve symptoms by helping individuals
in better concentration, in being less impulsive and being calmer.
Therapies-
 Psychoeducation, in which the individuals are made to discuss their disorder and cope
with it.
 Behavior therapy, which involves the caregiver in developing a reward system to help
control their symptoms.
 Parental training and educational programs.
 Cognitive behavior therapy, which is a talking therapy in which the therapist helps
individual in managing their outlook towards their own behavior (Sprich et al., 2016).
Other treatments-
 Maintaining a healthy diet and avoiding food like sugar, additives, caffeine which
aggravates the symptoms.

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 Supplements containing omega-3 and omega-6 fatty acids have been researched to be
beneficial (Patrick & Ames, 2015). However, long-term intake is not advised.
Survey of current research-
ADHD has been a huge problem for many people and has therefore been the centre of
numerous clinical researches. ADHD was thought to be a behavior disorder however recent
findings from bran imaging, neuroscience and clinical research has helped in understanding that
ADHD is a developmental disorder in which the executive functions on an individual is impaired
(Blank, Polatajko & Wilson, 2012). This has therefore; helped in assessing and understanding the
disorder that affects almost 9% of the children and 5% of the adults (Martin et al., 2017).
Research shows that each individual suffering from ADHD has certain activities in which they
have a strong personal interest in where their executive functions are not impaired. Studies have
shown that performance of individuals with ADHD is very sensitive to factors that are
contextual, like, nature of the task, rewards, physiological factors and cognitive factors
(Rommelse et al., 2015).

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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Blank, R., SMITS‐ENGELSMAN, B. O. U. W. I. E. N., Polatajko, H., & Wilson, P. (2012).
European Academy for Childhood Disability (EACD): Recommendations on the
definition, diagnosis and intervention of developmental coordination disorder (long
version). Developmental Medicine & Child Neurology, 54(1), 54-93.
Martin, A. J., Cumming, T. M., O’Neill, S. C., & Strnadová, I. (2017). Social and Emotional
Competence and At-Risk Children’s Well-Being: The Roles of Personal and
Interpersonal Agency for Children with ADHD, Emotional and Behavioral Disorder,
Learning Disability, and Developmental Disability. In Social and Emotional Learning in
Australia and the Asia-Pacific (pp. 123-145). Springer, Singapore.
Patrick, R. P., & Ames, B. N. (2015). Vitamin D and the omega-3 fatty acids control serotonin
synthesis and action, part 2: relevance for ADHD, bipolar disorder, schizophrenia, and
impulsive behavior. The FASEB Journal, 29(6), 2207-2222.
Rommelse, N., Bunte, T., Matthys, W., Anderson, E., Buitelaar, J., & Wakschlag, L. (2015).
Contextual variability of ADHD symptoms: embracement not erasement of a key
moderating factor.
Sprich, S. E., Safren, S. A., Finkelstein, D., Remmert, J. E., & Hammerness, P. (2016). A
randomized controlled trial of cognitive behavioral therapy for ADHD in medication‐
treated adolescents. Journal of Child Psychology and Psychiatry, 57(11), 1218-1226.

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Storebø, O. J., Ramstad, E., Krogh, H. B., Nilausen, T. D., Skoog, M., Holmskov, M., ... &
Gillies, D. (2015). Methylphenidate for children and adolescents with attention deficit
hyperactivity disorder (ADHD). The Cochrane Library.