Child Health
Attention Deficit and Hyperactivity Disorder (ADHD)

​​Overview:

  • Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that occurs in childhood, and continues through adolescence and adulthood in various forms and with various symptoms.
  • The direct or precise cause of ADHD remains unknown; however, there are some studies that have proven a link between the disorder and some factors.
  • Medications are effective in controlling symptoms; however, medications don’t substitute for behavioral and educational therapy.
  • There are no specific tests through which ADHD can be diagnosed; ADHD diagnosis, therefore, is conducted by a therapist.
  • ADFD cannot be prevented on the onset of more than one risk factor. However, the risk of ADHD can be reduced.​

Definition:
ADHD is a neurodevelopmental disorder resulting from deficiency of neurotransmitters (i.e., dopamine and noradrenaline) in the frontal cortex (frontal lobe) that allow the cells to carry out their functions, and link the parts of the brain to one another.

Names
Attention deficit and hyperactivity disorder (ADHD)

Types:
Some symptoms may be more severe than others; this, however, does not necessarily mean the absence of other symptoms. The incidence of symptoms may vary according to age (for instance, hyperactivity and impulsivity may at preschool age, whereas inattention and distractibility appear during school age). 
  1. ADHD, inattentive and distractible type:
    • This type of ADHD is often associated with inattention/ distractibility symptoms.  
    • The incidence of this type is higher in females than males.
  2. ADHD, hyperactive/impulsive type:
    • This type is often associated with hyperactivity/ impulsivity symptoms.
    • Its incidence is higher in males than females.
  3. ADHD, combined type:
    • The symptoms include both inattention and hyperactivity/ impulsivity.
    • It is the most common type of ADHD.
    • Patients with this type show a combination of the symptoms of the two afore-mentioned types: inattention, and hyperactivity/ impulsivity, in an almost symmetrical manner.
Coexisting conditions:
  • Patients with ADHD may also suffer one or more of the following disorders:
  • Learning disabilities:
    • ADHD patients find it difficult to organize, understand and respond to orders or requests.
    • Difficulties reading and calculating are the most common among children with ADHD.
  • ​Oppositional defiant disorder (ODD):
    • Children with ODD are argumentative, impatient and easily irritated. They refuse to abide by the rules, blame others, and intentionally disturb them.
    • They are often violent (verbally and physically) with both people and animals. They can also lie, steal, or flee from home or school. As for adults with ODD, they usually get themselves in legal troubles, owing to their violent disposition.
  • Mood disorders:
    • These disorders include depression, mania and bipolar disorders.
    • These disorders are characterized by a highly moody temperament. A child suffering these disorders may cry or panic for a long time, maybe days, without any reason.
  • Anxiety disorders:
    • Persons suffering this type of disorders have excessive anxiety about family, school or even work affairs.
    • Anxiety disorders usually begin with a feeling of stress and insomnia. In severe cases, patients may experience panic attacks.
  •  ADHD may be experienced by patients with:
    • Autism
    • Tourette syndrome
  •  Similar disorders:
    • Sleep disorders
    • Thyroid disorders
Causes:
The direct or precise cause of ADHD remains unknown; however, there are some studies that have proven a link between the disorder and some factors (e.g. family history, exposure to environment toxins, injuries during pregnancy, delivery or the post-delivery period).

Symptoms:

  • Inattention/ distractibility:
    • Inattention to details, and making careless mistakes;
    • Problems focusing or paying attention;
    • Appearing to be unable to listen or follow through a conversation;
    • Easy distractibility by factors or events usually ignored by others;
    • Difficulty carrying out instructions, especially if complicated or serial;
    • Disorganization and inability to arrange things;
    • Aversion and avoidance of tasks requiring continuous focus and mental effort;
    • Easily losing things;
    • Forgetfulness about daily activities;
    • Moving from an activity to another without accomplishing either of them.
  • Hyperactivity:
    • Difficulty staying seated for long;
    • Running or climbing a lot when it's not appropriate (in children);
    • Talking excessively;
    • Always playing with hands or legs (like swinging legs while seated);
    • Having trouble playing quietly or doing quiet hobbies;
    • Impatience.
  • Impulsiveness:
    • Eagerness to answer questions before fully asked, and impatience to get the teacher's permission to participate in class;
    • Having a hard time waiting in lines or queues;
    • Frequently interrupting others;
    • Inability to reflecting on events, or considering the consequences;
    • Recklessness and eagerness to participate in hazardous activities;
    • Inability to restrain their thoughts regardless of the context.
  • Other:
    • Disorganization;
    • Difficulty forming and maintaining relationships;
    • Lack of self-esteem;
    • Importunity;
    • Eager to impress the others and draw their attention;
    • Paying no attention to personal cleanliness and appearance.
Healthy people may normally experience some of these signs and symptoms. However, ADHD will be suspected if:
  • The symptoms are severe;
  • The symptoms appear frequently; or
  • The symptoms affect the person's social life, study or productivity.
When to see a doctor?
  • If the symptoms occur in at least two different settings (home, work, school, etc.);
  • If the symptoms significantly affect several aspects of the person's life (social, professional, educational, etc.);
  • If the symptoms occur in children under 12 years old;
  • If the symptoms persist for longer than six months, provided that they are not associated with a disease, or an emotional or mental shock.

Diagnosis:
There are no specific tests through which ADHD can be diagnosed; ADHD diagnosis, therefore, is conducted by a therapist through:
  • Physical examination: to help rule out other possible causes for your symptoms;
  • Information gathering: such as asking you questions about any current medical issues, personal and family medical history, and the history of your symptoms;
  • ADHD rating scales or psychological tests (Conner's Scale).

Risk factors:
  • Genetics (most cases);
  • Exposure to environmental toxins (e.g. high level of lead, mercury or chlorpyrifos pesticides) during pregnancy or post-delivery;
  • Low birth weight;
  • Deficiency of oxygen;
  • Smoking, alcohol or doping during pregnancy.

Complications:
  • Poor physical and mental health;
  • Poor school or work performance, and unemployment;
  • Trouble with the law and committing crimes;
  • Frequent car accidents or other accidents;
  • Unstable relationships;
  • Alcohol or other substance misuse;
  • Suicide attempts.

Treatment:
The treatment of ADHD depends on three key, mutually-reinforcing strategies:
  • Medications: help increase the level of focus and attention for a longer time, as well as reduce hyperactivity and impulsivity. ADHD medications are of two types:
  • Stimulants: boost the levels of brain chemicals called neurotransmitters, and hence increase the level of focus and control over behaviors;
  • Non-stimulant drugs (suppressants): strengthen the chemical receptors in the brain, and hence boost the efficiency of neurotransmitters and improve the patient's ability to focus.
  • Behavioral and educational therapy: This therapy relies on changing the child's behaviors by following certain educational methods and strategies, in order to replace negative behaviors with positive ones, and help the child acquire new skills.
Medications are effective in controlling the main symptoms; however, medications don’t substitute for behavioral and educational therapy.

Prevention:
Prevention of ADHD is difficult (almost impossible in the case of the onset of more than one risk factor). There are certain ways that, though not adequately scientifically proven to be effective, may help reduce the risk of ADHD, including:
  • Protecting the child (during pregnancy and post-delivery) from exposure to environmental toxins (e.g. lead in, for example, paints), mercury and pesticides.
  • Avoid smoking (especially during pregnancy) by both parents, and staying in places where smoking is allowed.

FAQ:
  • Does ADHD disappear in adults?
    • Some ADHD symptoms (e.g. hyperactivity) may not be clear in adults. However, other symptoms (e.g. impulsivity and inattention) may remain unchanged.
  • Can ADHD be detected in the pre-marriage checkup?
    • ADHD cannot be detected before marriage, since the gene or chromosome causing it remains unknown.


Myths & Truths:
  • ADHD serves only as a pretext for the parents to spoil their children, or as an excuse for their misconduct.
    • Truth: There are children who do now show ADHD symptoms even though receiving the same treatment received by ADHD patients. Studies were conducted on adopted children, whose biological parents are affected by ADHD. Although they are brought up in families not suffering the disorder, still they showed ADHD symptoms.
  • Causes of ADHD are: bad education, emotional shocks, addiction of screens and video games, watching TV for a long time, physical inactivity, food-induced allergy, and heavy intake of sugar and processed food.
    • Truth: ADHD is caused by a neurobiological disorder attributable to a chemical deficiency in the neurotransmitters in the brain. Its triggers are most likely genetic. The above-mentioned factors (bad education, addiction of screens, etc.) are not the triggers of ADHD, but may increase its severity.
  • Stimulants lead to addiction.
    • Truth: Stimulants are relatively safe, and don't lead to addiction.

Clinical Ed​ucation General Department
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