“My son, when he was younger, he would just run off,” recalls Prithi, an Indian expat based in UAE who requested that only her first name be used. “He would scale walls and jump over gates – he was very hyperactive.”
Prithi’s now 18-year-old son was diagnosed with attention-deficit/hyperactivity disorder (ADHD) when he was in nursery. The condition is one of the most common mental disorders affecting about 5 to 8 per cent of the global population, says the Al Zahra Dubai hospital.
Lowered attention span
Constant activity
Can’t sit still during meals or class
Fidgeting and restlessness
Learning difficulties
Clumsiness
High energy
Fighting and undisciplined
Dr Arif Khan, Founder, CEO and Consultant Paediatric Neurologist at UAE-based Neuropedia, explains that ADHD is a “neuro-behavioural disorder”.
“People with ADHD seem restless at all times, they may have difficulty in concentrating and may act impulsively. The exact cause of ADHD is not fully understood, but we know that a combination of different factors are responsible. ADHD tends to run in families, and it is now known that the genes one inherits from their parents are a significant factor in developing the condition,” he says.
However, genes may not be the only element that leads to ADHD. Other risk factors include:
- Prematurity or low birth weight
- Epilepsy
- Brain damage before birth or after a severe head injury later in life
- Maternal smoking
- Maternal alcohol use
- Extreme stress during pregnancy
In Prithi’s case, she mulls, there are instances of autism and ADHD – most undiagnosed – in the family tree. The two disorders are often found to overlap. However, this didn’t automatically put her son in the line for medication; for many years, his parents used alternative treatments – and psychologist and counsellor intervention – to better his concentration skills. “I think he did well. Over time, his hyperactivity reduced. And he found ways to cope,” she says. Things came to a head when he reached high school, where school counsellor and teachers would alert his parents to the bored, glazed look in his eyes, or his inability to pay attention.
Kids or adults with ADHD don't feel the motivation and need for normal tasks. The brain reward system will restrict them from engaging in such activities that don't stimulate their brains to release excitement or happiness hormones. That's why they are in constant activity.
They all agreed that for some time at least, he’d need some medicines to help him along. He has since been on two courses of medication a year or two apart.
“It is tough and can get tiring – as a parent of someone with ADHD, you really need help and support, to help your child feel accepted and understood,” says Prithi. “Sometimes, people can label them as naughty, but that’s not why they are behaving a certain way. I didn’t go to work because I felt I needed to be with him, but I think [ADHD symptoms] differ in different people,” she adds. “You just need to be patient.”
Types of ADHD
There are, explains WebMD, more than one type of ADHD. It could be, says the American medical website:
Predominantly Inattentive Presentation: It is hard for the individual to organise or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.
Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.
And then there’s a combined presentation. The symptoms – and type – may evolve over the ages as a person’s brain develops.
How does the ADHD brain process stimuli?
The brain of someone with ADHD works differently than a neurotypical brain. Dr Khan explains: There is an area of our brain called the pre-frontal cortex (PFC). It is responsible for mediation of ‘top-down’ attention, regulating our attention so that we devote our resources to that which is relevant and important to our goal and plans. It allows us to focus and sustain our attention. It helps us inhibit internal and external distractions. This PFC in children with ADHD does not function optimally and has differences in its circuitry as compared to the brains of neurotypical children.
“The ADHD brain needs constant stimuli to keep itself satisfied and these children are always looking for a reward experience by various means. This is primarily due to low level of neurotransmitters passing signals between the PFC and a structure called basal ganglia. The most important of these neurotransmitters is called dopamine is closely associated with the reward centre and helps us regulate mood. Low levels of this neurotransmitter drive the individual to seek the ‘reward feeling’ by various means.”
The result? A kid on the lookout for gratification. “Kids or adults with ADHD don't feel the motivation and need for normal tasks. The brain reward system will restrict them from engaging in such activities that don't stimulate their brains to release excitement or happiness hormones. That's why they are in constant activity or trying to engage in tasks that will activate the brain to reach a satisfaction level,” explains Dr Khan.
This ‘dopamine chase’ could be the link between ADHD and type 2 diabetes. One Swedish paper found that adults with ADHD were twice as likely to have Type 2 diabetes as their non-ADHD counterparts, reported US-based ADDitude Magazine, possibly a result of the reward channels lighting up because of an influx of sugar and simple carbohydrates.
Karan, who asked that his name be changed for privacy, was someone who suffered as a child with undiagnosed ADHD – they called him naughty, fidgety and imprudent in class. He dropped out of school, still not understanding what was wrong with him; his thoughts a mess. It was only in his 30s that he was diagnosed and medicated. “It was like my vision cleared,” he says. “I could suddenly understand how a normal person can focus on things like conversation.” Things most people take for granted.
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