ADHD

Currently, the number of diagnoses is increasing as we gain a better understanding of what ADHD is. It is often an invisible difficulty that many people struggle with throughout their lives without adequate support. Meanwhile, understanding, help, and appropriate strategies can significantly improve the quality of life for people with this disorder. 

Causes 

The main cause of ADHD is differences in brain function. This disorder is classified as neurodevelopmental because, from an early age, the brain develops differently, resulting in abnormalities in the functioning of the central nervous system. In people with ADHD, individual brain structures mature unevenly. This alters the way neurotransmitters travel between cells, especially in areas responsible for attention and memory. 

Scientists point out that both genes and the environment shape brain development, but they consider genetic factors to play a particularly important role in ADHD. This disorder shows a very high degree of heritability. There are also risk factors that can increase susceptibility, such as adverse conditions during pregnancy, for example, infections, maternal smoking, or pre-eclampsia. 

Symptoms 

People describe ADHD through three main types of symptoms: hyperactivity, impulsivity, and attention difficulties. However, their severity can vary significantly from person to person, so it is essential to recognize that each case is unique. 

The first signs usually appear in childhood, but they are not always noticed immediately. The disorder most often becomes apparent when a child starts school, faces new responsibilities, and enters into relationships with peers. This is when the symptoms often intensify, prompting parents to seek a specialist’s consultation. 

As the child grows up, the symptoms may change in nature. Although many people associate ADHD mainly with children, the disorder often persists into adulthood. In adults, the symptoms may manifest in different forms, affecting personal and professional life, as well as relationships with others. 

Hyperactivity 

Hyperactivity in ADHD can take many forms. It is most often associated with excessive physical activity. The child fidgets constantly, gets up from their seat, swings their legs, drums their fingers, or touches everything around them. They find it difficult to sit still at their desk or at the table, and their need for movement seems uncontrollable. In adults, hyperactivity often takes a more subtle form. It can manifest itself in fidgeting, walking quickly, constantly adjusting clothing, playing with a pen, or a feeling of inner restlessness that makes it difficult to relax. 

The second dimension of hyperactivity is its mental form, i.e., an excess of thoughts and difficulty in calming them down. In children, this may look like jumping from topic to topic, talking quickly, interrupting others, or performing tasks chaotically. In adults, mental hyperactivity more often manifests itself as racing thoughts, difficulty focusing on one thing, quickly becoming stressed, or excessive planning and deliberation. 

There are also differences between the sexes. Boys are more likely to manifest hyperactivity through physical movement. They are louder and more boisterous, which means they are more likely to be observed by specialists. In girls, however, hyperactivity is less obvious. Instead of running around or fidgeting, they may talk more, move their hands nervously, or exhibit internal tension. They often appear dreamy, distracted, or emotionally agitated, which can be mistaken for shyness, anxiety, or sensitivity. 

Impulsivity 

Impulsivity in ADHD is the difficulty in stopping oneself from acting, thinking, or speaking. In children, it often manifests in a very visible way: they answer before someone has finished asking a question, take risky actions without thinking, or react emotionally in a fraction of a second. They have very limited patience. They find it difficult to wait their turn, become impatient quickly, and find waiting for results frustrating. Boredom is extremely difficult for them to bear; when something does not immediately engage them, they begin to fidget and seek out stimuli.

In adults, impulsivity can manifest differently, for example, by making rash financial decisions, suddenly quitting a job, engaging in impulsive eating, shopping, or saying things they quickly regret. People with ADHD often have trouble listening until the end, react too quickly to criticism, or struggle to control their emotions.

In boys, impulsivity more often takes the form of violent reactions, getting into conflicts, disturbing others, and taking physical risks. In girls, however, it is more often verbal or emotional. They may speak without thinking, react with crying or laughing at inappropriate moments, or quickly feel guilty after a reaction that is difficult to take back. Sometimes impulsivity in girls and women is confused with emotional hypersensitivity. 

Attention Deficit 

Problems with attention and concentration are also important aspects of ADHD. Children are easily distracted, forget what they were supposed to do, lose things, do not finish tasks they have started, or drift off, even during interesting activities. They can only focus intensely on things that provide strong stimulation, and when a task is monotonous, their attention switches off almost automatically. Teachers and parents may interpret this as laziness or a lack of motivation, but the problem lies in the brain’s mechanisms. 

In adults, difficulties with maintaining attention appear differently than in children, but they are equally troublesome. They can manifest themselves in procrastination, problems with concentration during conversations, forgetting deadlines, chaos at work and at home, and starting multiple tasks without completing them. They often need time pressure or clear deadlines to finish anything at all, and living in constant disorder leads to fatigue and stress. 

Boys often combine attention problems with hyperactivity, which makes the symptoms more noticeable—they fidget, disrupt others, struggle to sit still, and find it hard to focus on tasks. In girls, however, concentration problems tend to be less noticeable. They may appear pensive, quiet, and calm, which is sometimes misinterpreted as a sign of concentration. In reality, their thoughts drift easily, and it is difficult for them to maintain their attention on a task. 

Effects 

People with ADHD encounter many difficulties, and their symptoms can affect all areas of functioning, significantly hindering daily life. 

Speech Disorders 

Children with ADHD often have speech disorders. Their speech skills may develop late. They also have problems with articulation, i.e., the clear and correct pronunciation of individual sounds, as well as difficulties in constructing sentences correctly. Kids may mix up word order, leave out parts of sentences, or express themselves in a way that doesn’t make sense, which makes it hard for them to convey their point. Additionally, hyperactivity and impulsivity can cause them to speak too quickly, interrupt others, or abruptly change the subject, which further complicates communication. In adults, speech disorders may still manifest themselves in a more subtle form. 

Difficulties in Relationships 

ADHD fundamentally affects relationships with other people. Children experience problems in establishing connections with their peers. Delays in speech development or trouble expressing their thoughts can make them feel misunderstood and lead to social withdrawal. Additionally, some symptoms, such as impulsiveness or hyperactivity, can lead to conflicts and rejection by the group. In adults, time management difficulties and failure to meet commitments can also affect friendships, family relationships, and professional relationships. 

Anxiety Disorders 

People with ADHD are also more likely to experience anxiety. Difficulties with concentration, impulsivity, and problems with organizing daily affairs make many situations in life overwhelming. Children may feel anxious at school when they are afraid of making mistakes or reacting excessively to criticism from teachers. In adults, the difficulties associated with ADHD also cause anxiety. Anticipating threats, stress related to missing deadlines or unfulfilled responsibilities becomes part of everyday life. Anxiety often co-occurs with other emotional problems, such as feelings of frustration, perfectionism, or difficulty making decisions. 

Aggression 

People struggling with this disorder also experience anger and frustration more often, which increases their aggressiveness. However, in people with ADHD, this is often not due to ill will but is a consequence of difficulties in regulating emotions and impulsivity. However, this is not always understood by those around them, which often results in feelings of guilt and low self-esteem in patients. 

Sleep Disorders 

Experiencing excessive fatigue is another problem faced by people with ADHD. They often have sleep disorders due to different brain functioning mechanisms that affect circadian rhythm regulation. Difficulties in calming thoughts and excessive stimuli can cause problems with falling asleep. Hyperactivity and mental agitation can make sleep restless, preventing the patient from reaching the deep stages of sleep. In addition, disturbances in the regulation of neurotransmitters such as dopamine and noradrenaline can cause early awakening or difficulty in maintaining continuous sleep. Anxiety, stress, and tension resulting from the daily difficulties associated with ADHD further exacerbate sleep problems, creating a vicious circle. 

Diagnosis 

The disorder is most often diagnosed around the age of 7, although the first signs may be visible earlier. Excessive mobility may attract attention as soon as the child begins to walk, and additional signs include problems with appetite or reduced sleep. 

Sometimes ADHD is not diagnosed in childhood. This is often due to a lack of awareness of how varied its symptoms can be. As a result, doctors often do not diagnose many people until they reach adulthood. Even then, the process can be difficult, as the symptoms of ADHD in adults often resemble those of anxiety or depression, leading to inappropriate treatment. Therefore, when making a diagnosis, it is crucial to gather information about how the person functioned in childhood. 

The diagnostic process involves a detailed interview with the patient and, in the case of a child, also with their parents. In the youngest children, psychological investigations may consist of observation during play. It is important to assess intellectual ability, concentration, memory, and motor coordination. 

Symptoms are determined on the basis of professional classification systems and must persist for at least six months and clearly interfere with life in various areas. Specialists also use standardised psychological tests and questionnaires to diagnose the disorder accurately. 

Treatment 

ADHD is a neurodevelopmental disorder, so no one can completely cure or prevent it. The brain develops in a certain way, and we cannot reverse this process. However, people with ADHD can learn how to manage the disorder and reduce its impact. For children, support from parents and teachers is extremely important. They should know how to respond to difficult behaviour and how to create a suitable environment. In many cases, therapeutic classes for children can also be helpful.  

When symptoms reach a moderate or severe level, doctors also use pharmacological treatment. They most commonly prescribe stimulant medications to improve attention and reduce internal chaos. In adults, clinicians usually combine medication with psychotherapy. Therapy helps them to organise themselves better, cope with stress, control their impulses, and improve their relationships with others. Medications work in a similar way – they reduce symptoms and make it easier to concentrate. 

Sources

• Warren Magnus, Arayamparambil C. Anilkumar, Kamleh Shaban (2023). Attention Deficit Hyperactivity Disorder. https://www.ncbi.nlm.nih.gov/books/NBK441838/
• Institute for Quality and Efficiency in Health Care (2022). Overview: Attention deficit hyperactivity disorder (ADHD). https://www.ncbi.nlm.nih.gov/books/NBK321129/
• Sarah Steinau (2013). Diagnostic Criteria in Attention Deficit Hyperactivity Disorder – Changes in DSM 5. https://pmc.ncbi.nlm.nih.gov/articles/PMC3667245/