Better understand Attention Deficit Disorder (ADHD)

ADHD is an acronym that stands for attention deficit and/or hyperactivity disorder according to the DSM-V. Under this name lie three recognized forms of the disorder. A first form mainly affects attentional capacities, the ability to stay focused for a long time on certain tasks. The second form affects psychomotor activity, which is higher than average, with frequent changes in activity and difficulty remaining without doing anything. The last form presents an association of the first two, with impaired attention and hyperactivity.

These forms are defined in relation to the most frequent symptoms, that is to say the signs which have a significant impact on the life and functioning of individuals.

ADHD is a neurodevelopmental disorder, which means that clinical signs appear during childhood and can continue into adulthood. It sometimes happens that the symptoms of ADHD are discreet during childhood thanks to a supportive environment, and that they appear more salient in adulthood, when the person is more demanded and the stressors reduce the resources available to manage the dysfunctions.

For a growing number of researchers, ADHD is actually not an attention deficit, because we can observe ADHD people, in certain situations, maintaining intense and sustained attention for hours. It would in fact be more of a deficit in the regulation of attention and emotions, associated with a need for stimulation.

Like most neurodevelopmental disorders, the signs of ADHD fall into two categories: symptoms and specificities.

symptoms are clinical signs that cause significant suffering or dysfunction in cognitive functions or daily functioning. The specificities are other signs frequently found in people with the disorder, but which are not necessary for the diagnosis. However, they can help ensure that the diagnosis is made correctly.

Symptoms are classified in diagnostic manuals. The DSM V defines ADHD as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development and is characterized by a number of the following signs:

Inattention

Six or more of the following symptoms:

• Fails to pay attention to details or makes careless mistakes
• Often has difficulty sustaining attention at work or in games
• Often seems not to listen when spoken to personally
• Does not comply with instructions and fails to complete his duties, domestic tasks or professional obligations
• Often has difficulty organizing his work or activities
• Avoid, dislikes, or reluctantly does tasks that require sustained mental effort.
• Often loses the objects needed for his work or activities.
• Is easily distracted by external stimuli.

Has frequent forgetfulness in daily life.

Hyperactivity and impulsivity

• Moves hands or feet often or squirms in seat

• Stands up often in class or other situations where he is supposed to stay seated

• Runs or climbs everywhere, in situations where this is inappropriate (in adolescents and adults, this may be limited to a feeling of restlessness)

• Often has difficulty remaining still during games or leisure activities.

• Is often "on the go" or often acts as if he were "on a spring"

• Often talks too much.

• Often lets slip the answer to a question that has not yet been fully asked.

• Often has trouble waiting his turn.

• Hyper-concentration: When a person suffering from ADHD begins a task that provides a high level of stimulation, it is possible to lose track of time and spend hours on this task, sometimes forgetting to eat or go to the bathroom. The task is often interrupted by an external source or a bodily sensation strong enough to break concentration.

• Emotional sensitivity and/or instability: people diagnosed with ADHD have a greater difficulty in regulating their emotions internally, which can lead to a more intense or stressful perception of unpleasant emotions. The way their attention works can also lead to a rapid change of emotions depending on events and stimulation.

• Sleep disorders are also common among people with ADHD, with difficulties with emotional and attentional regulation making it difficult to maintain a regular, healthy rhythm of sleep.

• Boredom intolerance: Boredom is particularly difficult to manage for people with ADHD who have a higher need for stimulation. Boredom is a form of understimulation that can lead to strong agitation, greater difficulty concentrating and directly influence mood and emotions.

• Weak working memory: remembering task lists, the different steps of a process, a name or a telephone number, these are exercises that can be particularly difficult for people with ADHD, who can quickly become overwhelmed by a large amount of information.

• Time blindness: This is a poor perception of the passage of time and the time needed to complete certain tasks, which can lead to regular delays, deadlines that are not respected and the difficulty of following a routine on time.

• Impaired object permanence: Object permanence means that an object continues to exist in a person's mind even if it is not in their visual field. In people with ADHD, it is not as absent as in babies who completely forget the existence of a non-visible object, but it makes it more difficult to remember objects and people who do not have a regular presence in their lives.

• Executive dysfunction: executive functions are all of the mental processes that allow you to plan and carry out everyday actions. They include the capacities of planning, flexibility, adaptation, inhibition and execution. In ADHD these abilities are impacted by difficulty in correctly filtering information from the environment, a lower level of inhibition and poorer planning skills. This makes carrying out common tasks more difficult, requiring very much effort to carry out simple tasks. Depending on the resources a person has, some tasks are mentally impossible to perform.

ADHD is a disorder of neurodevelopment, this means that it is due to differences in the development of certain brain structures.

The first hypothesis etiology of the appearance of ADHD is genetics. Research shows that children born into a family where one or more members have been diagnosed with the disorder are more likely to be diagnosed with ADHD themselves.

Of environmental factors also appear to increase the risk of the disorder developing: alcohol exposure, lead, stress during the pregnancy, a premature birth, a head trauma, abuse, etc.

The tracks neurobiological and neuropsychological are increasingly explored, trying to identify the brain areas who would be responsible of ADHD. Some have been identified as slightly underdeveloped in people with the disorder, but these volume variations are not not sufficient to make a diagnosis on these values only. In particular, we can note the pre-frontal cortex which would be underactivated, which leads to inhibition fault.

The track of the dopamine is also explored in relation, in particular, to need for stimulation. People with ADHD have levels dopamine, the pleasure and reward hormone, weaker than the general population, which leads to a seeking higher stimulation and a greater intolerance to boredom.

The treatment of ADHD, especially when the diagnosis is early, is multidisciplinary and is carried out according to the needs of the individual.

The lines of work are threefold:

• Work on cognitive and functional abilities: this work is done with the help of psychologists, speech therapists, psychomotor therapists and occupational therapists. The objective will be to train the failing cognitive functions and to find alternative strategies. The idea is to understand that the brain functioning of a person with ADHD is different from that of a neurotypical person, and that we must therefore find a mode of functioning that suits the person and their development in a social environment. The sooner the person is treated, the more effective the cognitive remediation will be.
• Medications: certain specialist doctors (psychiatrist, pediatrician, neurologist, etc.) can prescribe, when the diagnosis of ADHD is proven, a treatment based on methylphenidate, which serves to stabilize the level of dopamine in the brain, which improves alertness and ability to concentrate. It is a drug commonly used in the treatment of ADHD in North America and in certain European countries, and which is starting to become more popular in France. The main obstacle concerns people diagnosed in adulthood, because its delivery is based on the presence of signs of ADHD during childhood, which must be able to be proven.
• Adaptation of the environment: as much as possible, adapting the environment makes it possible to make life easier for a person suffering from ADHD, to save mental resources and to better concentrate on the elements of life that cannot be adapted. This adaptation also involves education of those around them who will have to adapt their functioning and their requests to the needs and limits of the loved one.

ADHD remains a disorder that suffers from its bad reputation and poor representation. Children with a form centered on hyperactivity suffer the most socially from this poor knowledge of the disorder. Despite the difficulties that ADHD brings, it can also be a strength when people are properly supported.

It is necessary to improve, on the one hand, the diagnostic process in order to avoid as many late diagnoses as possible, which increase life difficulties, but also to improve education around this disorder, particularly among childhood and early childhood professionals.