Attention Deficit and Hyperactivity Disorder: causes and a multidisciplinary approach

The term Attention Deficit and Hyperactivity Disorder is unfamiliar to our grandparents. As is its acronym ADHD. We are confronted with a relatively new diagnosis; in the past, these children were called fidgety, troublesome, they were often punished, and it was taken for granted that they were destined first to fail at school, then at work, and in general in society.

However, about 20 years ago, children, and sometimes their parents, began to be diagnosed with ADHD, because it is a condition with a strong genetic component, and medical prectitioners started recommending therapy, medication, and lifestyle changes. They began to see troublesome children from a more scientific point of view and started helping to adapt to school, to the home, and parents and teachers were taught how to deal with them so as to get the best out of them.

“ADHD is a neurobiological disorder that affects both children and adults, but the prevalence rate in addults is much lower. It has multiple causes and, when more than one cause is present, the probabilities of being diagnosed with ADHD increase“, defines Cinthya Molina, clinical psychologist at SHA Wellness Clinic.

Genetic factors are among the numerous causes that usually underlie this diagnosis. Family studies with twins have revealed that genes play an important role in the predisposition to ADHD. Multiple genes are thought to contribute to the development of this disorder, although the specific mechanisms are not fully understood yet.

Other research has found structural and functional differences in the brains of people with ADHD, especially in areas related to attention, inhibitory control, and behavioural regulation. These abnormalities may be present from birth or develop during early childhood. Some theories point to environmental factors, such as prenatal exposure to tobacco, alcohol, and other toxic substances. It is also believed that premature birth or low birth weight may increase the risk of developing ADHD. The disorder is associated with socio-economic problems, such as high levels of stress and poor family structure.

Finally, imbalances in neurotransmitters, such as dopamine, noradrenaline and serotonin, have been found to be associated with ADHD. These neurotransmitters are critical for regulating attention, impulsivity, and motor control.

“It is a diagnosis that is often confused with oppositional defiant personality disorder, because the hyperactivity component is associated with aggression and lack of impulse control. Sometimes, ADHD is diagnosed too quickly when it is a case of a behavioural disorder where the child seeks confrontation and challenge. And these are two completely different diagnoses, because one is of the neurobiological axis and the other one is of a purely behavioural axis that does not have genetic factors“, believes Molina.

The specialist confirms that many more cases of ADHD are diagnosed now as compared to a few decades ago. “There are more diagnosed cases, because there is more awareness, more information, and more training to identify the disorder. Moreover, since we love attaching labels for the sake of cognitive economy, as soon as we see a lively child, we already label it as hyperactive, but maybe it is just a fidgety child,” he reflects.

To prove the high frequency of the diagnosis, Molina contrasts two data. “The prevalence varies from country to country. Officially, the rates are between 3% and 4%. Nevertheless, other data assure that 10% of the child population in Spain is medicated with amphetamines, and this is the pharmacological treatment recommended for ADHD“.

“The recommended approach to treating ADHD is a combination of cognitive behavioural therapy, educational interventions, pharmacotherapy, and lifestyle changes, including diet,” explains Cinthya Molina. She further notes that device screens are a triggering factor for this disorder. “Screens activate the frontal cortex which is stimulated by light, movement, and sound. That is precisely what a screen has. It is very challenging to make a child who is hyperstimulated like this sit in a doctor’s waiting room and ask it to be quiet. Nor can it sit for eight hours in a classroom staring at a book. It cannot. Its reward system needs continuous stimulation and its threshold for motivation and attention decreases. Parents give children screens, because they calm and soothe them, but they are negatively reinforcing hyperstimulation“, warns the SHA Wellness Clinic expert.

ADHD is a disorder that has been associated with creative personalities. It is not surprising that many actors, sportsmen, and singers speak publicly about their disease, in order to raise awareness and support for those who suffer from it or to raise funds for research into the nature of this multiple-cause disorder.

Here are some of them:

Will Smith: The actor and rapper has spoken openly about his ADHD diagnosis and how he learned to manage the challenges associated with ADHD. He has shared how it affected his academic performance and how he found ways to overcome these obstacles.

Michael Phelps: Legendary Olympics swimmer Michael Phelps has shared his struggle with ADHD from an early age. Despite his diagnosis, Phelps has achieved extraordinary success in his career in sport, becoming the most awarded swimmer in the history of the Olympic Games.

Justin Timberlake: The singer, songwriter, and actor has publicly revealed that he was diagnosed with ADHD as a child. He discussed how he learned to manage his symptoms and advocated for greater awareness and understanding of the disorder.

Emma Watson: The British actress, known for her role as Hermione Granger in the Harry Potter saga, was diagnosed with ADHD as a child. In a number of interviews, she has described how this disorder has affected her life and how she has learned to manage the disease.

Adam Levine: The singer and frontman of the band Maroon 5 has shared how his personal and professional life was affected by an ADHD diagnosis. In addition, he has shared that music and the support of his family helped him to keep going.