The ADHD series: What science tell us about ADHD
This is the first of a series of three articles on Attention-Deficit/Hyperactivity Disorder (ADHD). Read on to find out about the strengths and difficulties that come with ADHD.
By Dr Meghna Singhal
Myra is your average 7th grader. Except that she isn’t. She is called “spacey” by her peers and “forgetful” by her teachers. At home, her mother wishes that Myra could just pay attention to her studies and that homework wouldn’t be the war zone it is every day. “Myra, you can’t keep your papers like this. This is such a mess! How will you study if you can’t even keep your books and notebooks in one place?” her mother scolds her every day. What’s do difficult? Why does Myra keep making the same mistakes? What doesn’t she get? And then her parents worry about her future- what will become of Myra if she can’t get it together?
If you’re a parent of a child or teen with attention-deficit/hyperactivity disorder (ADHD), with or without hyperactivity, you have probably experienced the scenario above.
Why is daily life often harder for children with ADHD? They seem to struggle academically, socially, and emotionally. They forget things, can’t slow down, find it hard to focus, and space out regularly. They are disorganised, they feel overwhelmed, and have difficulty controlling their emotions. While they like their creativity, their ‘out of the box’ thinking, and their energy, they are usually ashamed of their shortcomings, want to avoid dealing with them, and often feel powerless to change them. Similar to all children, they just want to be ‘normal’.
As a parent, you watch them struggle every day. It’s as difficult for you as it is for them. Its important to remember that children with ADHD are doing the best they can with their skills—skills that are compromised by the inherent complexities of having ADHD, such as challenges with concentration, impulsivity, and being able to remember things. With lots of myths and hearsay available on the internet or in casual conversation, one can easily assume that ADHD is just about being hyper, never paying attention, or lacking self-control. But an accurate understanding of ADHD- how it impacts one’s brain and behaviour- is immensely helpful.
With the latest research available from neuroscience and brain imaging, we now have a much more accurate understanding of ADHD than before. Let us examine what science tells us about ADHD and sieve it from the chaff that covers it:
ADHD is a biologically-based developmental disorder
ADHD is currently defined as a persistent pattern of inattention and/or hyperactivity that interferes with functioning or development. There are three types of ADHD: inattentive, hyperactive, and combined. ADHD is currently understood as a biologically based condition that impacts executive functions (or the parts of the brain that are responsible for higher order thinking skills of planning, decision making, problem solving, etc.). Thus, the old understanding of ADHD as a behavioural disorder is no longer tenable.
ADHD is fairly common across the world, affecting 5-9% of under-18 population. Inattention is the most common type reported. Boys are diagnosed twice as often as girls, mostly with the hyperactivity/impulsivity type probably because they tend to be more impulsive and their behaviour attracts more attention from adults. Girls, though, tend to be diagnosed later. Boys and girls tend to experience similar symptoms and both respond equally well to treatment. As children age, many of them continue to have ADHD, but it changes: hyperactive and impulsive symptoms usually fade away, and inattention remains.
There is no single known cause of ADHD
A number of factors have been found to lead to ADHD. The biggest one is genetic: ADHD is highly inherited. In fact, if you have one child with ADHD, there is a 33% chance that another child in your family will have it. Sometimes ADHD can stem from brain injuries, reoccurring trauma, alcohol or drug abuse, or tobacco use during the mother’s pregnancy or result from exposure to lead. Despite myths to the contrary, it is not caused by diet (including food additives or sugar), too much screen-time, or poor parenting.
ADHD brains have different structures that make them unique
There are significant differences in the brains of children and teens with ADHD compared to their non-ADHD peers:
- The size and volume of certain brain areas are smaller, thinner, and less active, which can affect maintaining and directing attention, managing behaviour and emotions, operating memory systems, and communicating between regions of the brain
- The ADHD brain matures more slowly. There can be a lag of up to 3 years, especially in an important area of the brain called the prefrontal cortex (behind your forehead). This is the last part of the brain to develop fully, reaching maturity in non-ADHD brains around age 25 years. However, over time ADHD brains catch up in their structural development
- In ADHD brains there is a problem in the way neurotransmitters- dopamine and norepinephrine- are manufactured, released, and reloaded. Dopamine affects pleasure, rewards, motivation and satisfaction; norepinephrine is related to alertness, sleep, and energy. That’s why children with ADHD struggle with paying attention, managing intense feelings, being overly energetic, or not sleeping well
ADHD co-occurs with learning or mental health issues
Learning Disabilities occur quite commonly in children with ADHD. Struggles with academic skills are found most commonly in areas of reading, math, and written expression, as well as motor coordination (the ability to use multiple body parts for a particular action).
Your daughter may read slowly or skim sentences too quickly without retaining their meaning.
Your son may struggle with learning math facts or have difficulty writing down his ideas on paper.
When a child receives an LD diagnosis, it means they are performing below their intellectual capability in certain areas and not achieving as would be expected of their same-age peers. Like ADHD, LDs are neurologically based, tend to run in families, and cannot be linked to physical ailments like hearing, vision, or physical problems.
Many children and teens with ADHD also deal with mental health issues, such as depression, anxiety, or disruptive behaviour.
Myths and Facts about ADHD
There are many misconceptions around ADHD, which make it difficult for children and teens to get the support they require in school and otherwise. Let us examine some common myths about ADHD and the reality behind them:
MYTH #1: Children with ADHD can’t ever focus
Fact: Children with ADHD do have trouble focusing, but they’re able to focus on things that interest them (a phenomenon called hyperfocus).
MYTH #2: All children with ADHD are hyperactive
Fact: Not all children with ADHD are hyperactive. There are 3 types of ADHD, and one of the types involves mainly problems with attention. For children who do have hyperactivity, it usually reduces with age.
MYTH #3: Only boys have ADHD
Fact: Boys are twice more likely as girls to have ADHD. But girls are much more likely to be overlooked and remain undiagnosed. This is partly because ADHD can present differently in girls—they tend to have less trouble with impulsivity and hyperactivity, and may seem more spaced out.
MYTH #4: Children with ADHD cannot do well in school
Fact: While some children with ADHD may struggle in school, they can also excel with the right support. There are Nobel Prize winners who have ADHD, self-made millionaires and CEOs, professional athletes, brain surgeons, best-selling authors and airline pilots, you name it. So, there is no reason to believe that a child with ADHD will never make it.
MYTH #5: ADHD is caused by bad parenting
Fact: ADHD is not caused by environmental factors like bad parenting (though it can make life difficult for sure!). One inherits a genetic predisposition to ADHD, which is then expressed due to the environment in which the child is raised. ADHD a neuropsychological condition, which causes brain differences, not something parents or caregivers do.
This is the first of a series of three articles on ADHD. In the second article, we cover how to seek help if you suspect that your child has ADHD, and how to deal with the denial of having a child with ADHD. In the third article, we will cover ADHD intervention and management.
In a Nutshell
- ADHD is a neuropsychological disorder of development, which involves inattention and/or hyperactivity that interferes with functioning or development
- There is no single known cause of ADHD though we know that it runs in families
- There are significant differences in the brains of children and teens with ADHD compared to their non-ADHD peers
- ADHD brings with it other mental health issues such as Learning Disability, anxiety, or disruptive behaviour
What you can do right away
- Having accurate information about ADHD (instead of hearsay) is important. Educate yourself on ADHD using reliable sources like ParentCircle
- Remember that its difficult for you as it is for your child with ADHD. Your child is doing the best he can with his skills—skills that are compromised by the inherent complexities of having ADHD
- Identify and focus on your child’s strengths and help her build those competencies. This will have a huge bearing on her self-confidence
About the expert:
Written by Meghna Singhal, PhD on 12 March 2020.
Dr. Singhal is the Manager, Global Content Solutions at ParentCircle. She has a doctorate degree in clinical psychology from NIMHANS (Bangalore) and holds a post-doctorate in parenting from the University of Queensland (Australia).
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