Throughout the process of growing up, children and teenagers have important experiences that affect their life’s progression and how they fit into society. The beginning years of one’s life are vital for the nurturing of the brain. This is a turbulent time for all adolescents, with obstacles bound to appear along the way. Approximately one in every ten children has another challenge to face: how to concentrate. Attention-deficit/hyperactivity disorder is the most commonly diagnosed childhood psychiatric disorder in the United States, and it has gained increasing recognition around the world as well. The term attention deficit disorder, or ADD, is frequently used colloquially, however it is no longer used in clinical practice.
Characterized by distractibility and inability to sit still, in the past, traits caused by the disorder were attributed to lack of effort or intelligence. ADHD does not have definite diagnostic tests, so many children without a willing and dedicated doctor were left not knowing the causes of their struggles. As its name suggests, the disorder has multiple facets, resulting in differing diagnoses for patients on differing places on the spectrum of ADHD. The three subtypes are predominantly hyperactive-impulsive, predominantly inattentive, and combined hyperactive-impulsive and inattentive (1).
Attention-deficit/hyperactivity disorder does not have definitive symptoms or diagnostic tests, but doctors have determined the criteria necessary to accurately assess patients. A child must display at least six of the listed symptoms for a minimum of six months to be diagnosed with ADHD. According to the Diagnostic and Statistical Manual of Mental Disorders, the symptoms of ADHD can be split into two categories, those of inattention and those of hyperactivity and impulsivity. Symptoms of inattention include failure to show attention to detail; difficulty maintaining attention when carrying out tasks or participating in activities; frequent failure to follow instructions or complete assigned duties; a disorganized approach to task completion or activity participation; forgetfulness; a tendency to be easily distracted by external stimuli; and frequent loss of items needed to complete tasks or activities. On the other hand, symptoms of hyperactivity and impulsivity include excessive fidgeting, squirming, or tapping of the hands and feet; an inability to remain seated or still when required; persistent restlessness; difficulty engaging in quiet activities; excessive talkativeness; regularly interrupting others; and difficulty waiting for one’s turn (2). These symptoms can cause great difficulties in a person’s everyday life, especially in workplace and school environments that necessitate uninterrupted productivity. For students with rigorous curriculums, this can greatly inhibit their ability to learn at the same speed as the other students and not fall behind. ADHD is more common in males than females, by two to threefold.
This is because boys tend to externalize behaviors caused by their attention-deficit/hyperactivity disorder, while girls internalize them, making them more likely to experience symptoms of anxiety, depression, or social withdrawal (2).In regards to the causes of attention-deficit/hyperactivity disorder, the brain pathology is only one aspect. A child’s environment and inherited genes can also play a role in the development of ADHD. Studies have shown that around 40% of people with ADHD inherited it from a parent (3). Environmental factors cannot be proven causes of attention-deficit/hyperactivity disorder, but they are widely thought to exacerbate pre-existing symptoms (2).
Such circumstances include low-income households, disorderly family structures, too much exposure to television in the young life, and too much sugar intake. The latter two were strongly believed in the past, however now they are considered hearsay. The first two, on the other hand, are more widely accepted as causes or triggers because of the stress it can cause children in their daily life (2). Along with many other illnesses, it is believed that premature birth, low birth weight, postnatal head injury cigarette, drug, or alcohol use during pregnancy and exposure to environmental toxins during pregnancy or at a young age all could play a role in causing cause ADHD (4).Studies and trials interested in determining how the brain of a person with ADHD differs from a normal brain are still very preliminary, but some have had successful findings.
Through magnetic resonance imaging, Dr. Nikos Makris and colleagues found that the left anterior cingulate cortex (ACC) is smaller volumetrically in ADHD patients than in healthy brains. The ACC is involved in executive function, cognitive processes, and emotional regulation, all clearly relating to the symptoms of attention-deficit/hyperactivity disorder (5). It has also been shown that in brains of those with ADHD, there is less tissue in the corpus callosum, the band of nerve fibers connecting the hemispheres of the brain. In addition, in normal brains, the right caudate nucleus is 3% larger than the left, however in ADHD brains, they are the same size. There is also less blood flow in the right caudate nucleus in brains with the disorder.
The caudate nucleus has many functions, including motor controls, goal-oriented actions, and different types of learning such as procedural and associative (1).Drugs used to combat symptoms of attention-deficit/hyperactivity disorder are known as stimulants; however, in the ADHD brain they cause the opposite, calming effect and promote focus (1). As shown in a study done at University of Wisconsin-Madison, common drugs pinpoint and increase the production of two neurotransmitters, dopamine and norepinephrine, in the prefrontal cortex, an important region for decision making. Dopamine plays a role in memory formation and addictive behaviors, and norepinephrine is linked to arousal and attentiveness (6).
Many ADHD medications have very intense side-effects, including decreased appetite, trouble sleeping, increased irritability, stomachaches, and headaches. In fact, lots of ADHD drugs are also used in treatment for narcolepsy or binge eating disorder, shedding some light on the reason behind the decreased ability to sleep or eat regularly (4). Despite these consequences, ADHD medications have been found to be overwhelmingly helpful in treating symptoms, with 80% of children responding favorably to them (2). This helpfulness, unfortunately, has a consequence of its own: illegal use, especially by college students.
Sean McCabe of the University of Michigan Substance Abuse Research Center noted that this behavior has had a tremendous increase over the past decade, and estimates that up to 30% of students use the stimulants non-medically (7). The students using the “study drug” see it as an easy way to gain focus, and do not pay much attention to the potential dangers its abuse could cause. In addition to medication for attention-deficit/hyperactivity disorder, cognitive behavioral therapy is also a treatment option. Therapists attempt to teach their patient how to monitor and control their emotions and resist urges (1).