Understanding ADHD: Signs and treatment approaches

In the UK, about 1.5- 2 million adults are estimated to have ADHD (attention deficit hyperactivity disorder), a neurodevelopmental condition that affects attention, organisation and behaviour.

Here to provide an expert insight into ADHD and its different treatment approaches is Dr Kaleem Baig, renowned consultant psychiatrist based in Winchester.

What is ADHD?

ADHD is a neurodevelopmental disorder characterised by persistent inattention and/or hyperactivity-impulsivity that affects daily functioning.

There are three main presentations:

• Predominantly inattentive presentation (ADHD-I): People with ADHD-I struggle primarily with inattentive behaviours.
• Predominantly hyperactive-impulsive presentation (ADHD-HI): People with ADHD-HI exhibit predominantly hyperactive and impulsive behaviours.
• Combined presentation (ADHD-C): ADHD-C is the most common presentation, where people exhibit both inattentive and hyperactive-impulsive symptoms.

The exact cause of ADHD is not fully understood, but it is believed to be a combination of genetic, neurological, and environmental factors. Research suggests that differences in brain structure and functioning, particularly in regions associated with attention and impulse control, contribute to the symptoms of ADHD.

How can ADHD symptoms impact different areas of life?

ADHD symptoms can have a significant impact on various areas of life, including:

• Academic or work performance: Inattention can lead to difficulty focusing on tasks, difficulty following instructions, or difficulty completing projects on time. Hyperactivity and impulsivity can lead to difficulty sitting still and staying organised. Both symptoms can also make it challenging to set and work towards long-term goals, as people may struggle with sustained focus and consistency.
• Social relationships: Impulsivity can lead to the interruption of other people’s conversations, difficulty taking turns, or acting without thinking about the consequences of one’s actions. Inattention can lead to missed social cues, not fully engaging in conversations, and seeming disinterested. Impulsivity and difficulty managing emotions can result in emotional outbursts, irritability, and difficulty controlling anger.
• Health and wellbeing: Difficulties with time management and planning can impact regular exercise routines and proper self-care. Over time, this can also affect an individual’s self-esteem and self-confidence.

Can ADHD coexist alongside other mental health conditions?

The relationship between ADHD and other mental health conditions can be complex, and it is important to recognise that one condition can influence the presentation and treatment of the other.

Mental health conditions that commonly coexist with ADHD include:

• Anxiety disorders: Generalised anxiety disorder, social anxiety disorder and panic disorder can occur alongside ADHD. People with ADHD might also experience heightened levels of anxiety due to difficulties with focus, organisation, and performance expectations.
• Depression: Depression is common in people with ADHD. Struggles with organisation, low self-esteem, and the challenges of daily life can contribute to feelings of sadness and hopelessness.
• Bipolar disorder: ADHD and bipolar disorder can share symptoms like impulsivity and mood swings, making accurate diagnosis and treatment planning important.
• Autism spectrum disorder (ASD): Some symptoms of ADHD overlap with those of ASD, such as difficulties with social interactions. Accurate diagnosis is crucial to differentiate between the two conditions.
• Obsessive-compulsive disorder (OCD): OCD and ADHD can have overlapping features, such as difficulties with focus and impulse control.
• Sleep disorders: Insomnia or sleep apnoea can exacerbate ADHD symptoms.

Accurate diagnosis and understanding of the interplay between conditions is crucial for effective treatment planning.

What are the different treatment approaches for ADHD? Are there both medication and therapeutic strategies?

Treatment for ADHD usually involves a combination of personalised approaches, including behavioural therapies, psychoeducation, and medication.

• Medication:

Stimulants are the most prescribed medications for ADHD and are recommended as the first-line medications by NICE. These include methylphenidate-based medications (for example, Ritalin, Concerta, Medikinet, Equasym) and Lisdexamfetamine (Elvanase), which help increase the levels of certain neurotransmitters in the brain, improving focus, attention and impulse control.

Non-stimulants are prescribed when stimulants have proven ineffective, are contraindicated, or if non-stimulant medication options are preferred instead. Non-stimulant medications include atomoxetine (Strattera) and guanfacine (Intuniv).

• Behavioural therapies:

Cognitive behavioural therapy helps to develop coping strategies to manage symptoms of ADHD, improve executive functions (for example, time management), and address negative thought patterns.

• Psychoeducation:

Education about ADHD, its symptoms, and its impact on daily life can help patients and their families to better understand the condition, develop effective strategies, and create supportive environments.

In a school setting, individualised education plans can provide accommodations (for example, extended time for assignments) and other academic support for a child’s specific needs. At home, creating structured routines and optimising the physical environment can help in the management of ADHD symptoms.

Above all, it is important to know that there is no one-size-fits-all approach to treating ADHD. Treatment should be individualised based on each patient’s specific symptoms, needs, and preferences. A comprehensive treatment plan will address the different aspects of ADHD symptoms and their impact on daily life.

Can lifestyle factors also help manage ADHD symptoms?

While diet, exercise, and sleep might not be direct treatments for ADHD, these factors play a role in the management of ADHD symptoms.

• Diet: A balanced diet rich in vitamins, minerals, and essential fatty acids supports brain health and avoids energy spikes. Staying hydrated can also prevent fatigue and decreased cognitive function.
• Exercise: Physical activity increases the release of neurotransmitters like dopamine and norepinephrine in the brain which play a role in attention and mood regulation. Exercise can also reduce stress and anxiety, which often exacerbate ADHD symptoms.
• Sleep: Poor sleep quality can worsen ADHD symptoms, leading to increased impulsivity, hyperactivity, and difficulty focusing. Establishing a regular sleep schedule and practising good sleep hygiene can improve sleep quality and overall functioning.
• Stress management: Chronic stress can exacerbate ADHD symptoms. Techniques like mindfulness, deep breathing, and relaxation exercises can help manage stress.

Dr Kaleem Baig is a highly regarded consultant psychiatrist with over 20 years’ experience.

If you require expert assessment, diagnosis and management for ADHD, don’t hesitate to book an appointment with Dr Baig via his Top Doctors profile today.