What Is Attention Deficit Disorder

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Concentration problems are a real scourge of modern society: more and more people complain of quick fatigue, distraction and inability to concentrate on an important task. This can be both a consequence of multitasking and information overload, and a manifestation of a specific mental disorder - attention deficit hyperactivity disorder. Theory and Practice tried to figure out what ADHD is and how to deal with it

Attention deficit hyperactivity disorder reveals all the weaknesses of psychiatry as a science: it is difficult to find a more controversial, vague and mysterious disorder. Firstly, there is a high risk of misdiagnosis, and secondly, scientists are still arguing whether this is a disease at all or a variant of the norm - and if it is still a disease, then whether ADHD can be considered a full-fledged diagnosis or is it just a set of symptoms, perhaps not united by one reason.

The history of studies on attention deficit disorder (which received its current name only in the second half of the twentieth century) began in 1902, when pediatrician Georg Frederic Still described a group of impulsive, poorly absorbing children and hypothesized that such behavior was not associated with developmental delay. The hypothesis was later confirmed - although the doctor could not explain the reasons for this phenomenon. 25 years later, another doctor, Charles Bradley, began prescribing benzedrine, an amphetamine-derived psychostimulant, to hyperactive children. Stimulants proved to be very effective, although again, for a long time, doctors could not understand the mechanism of their effect on patients. In 1970, American psychiatrist Conan Kornecki first put forward the hypothesis that the disease may be associated with low levels of certain neurotransmitters in the brain and similar drugs help to increase it. The American Psychiatric Association proposed the first methods for diagnosing the syndrome only in 1968, and in Russia they started talking about it only in the second half of the 1990s - and then without much enthusiasm.

The wary attitude towards this topic is understandable: the study of ADHD and the development of criteria for making a diagnosis has been accompanied by scandals since the 1970s - the creators of the American DSM-4 reference book were accused of causing a whole epidemic of overdiagnosis in children and adolescents. Some doctors and parents chose medication as the path of least resistance: it was easier to stuff difficult children with medication than to cope with their peculiarities using pedagogical methods. In addition, amphetamine-type drugs prescribed to active and uncontrollable children sometimes migrated into the arsenal of their housewives: stimulants gave strength and helped to cope with household chores (the most spectacular horror story about what the domestic abuse of such drugs leads to is the story of the mother the protagonist in Requiem for a Dream). In addition, the criteria for diagnosing the disorder changed several times, which also caused a flurry of criticism. As a result, attention deficit disorder was severely discredited and for some time was included in the top of "nonexistent diseases".

Nevertheless, the experience of psychiatrists has shown that the problem, no matter how you classify it, still exists: a certain percentage of the population experiences difficulties associated with poor concentration, inability to organize, impulsivity and hyperactivity. Often these features persist into adulthood, and manifest themselves strongly enough to create a person (especially an ambitious person) serious problems in school, at work and in personal life. But usually the disorder is perceived by others and by the patient himself, not as a serious illness, but as a manifestation of personal flaws. Therefore, most adults with such a set of symptoms do not go to doctors, preferring to struggle with their "weak character" by volitional efforts.

What life is like for someone with ADHD

Attention deficit disorder causes difficulties in patients even at school: it is difficult for a teenager with such a diagnosis, even if he has a high IQ, to assimilate the material, communicate with peers and teachers. A person with ADHD can plunge headlong into a topic that is subjectively interesting to him (however, as a rule, not for long - such people tend to frequently change priorities and hobbies) and show bright abilities, but it is difficult for him to perform even simple routine work. At the same time, he is bad at planning, and with a high level of impulsivity, he can foresee even the immediate consequences of his actions. If all this is also combined with hyperactivity, such a teenager turns into a school teacher's nightmare - he will receive poor grades in "boring" subjects, surprise others with impulsive antics, disrupt order and sometimes ignore social conventions (since it will be difficult for him to focus on expectations and requirements of others).

Previously, it was believed that the disorder "resolves" by itself with age - but according to recent data, approximately 60% of children with ADHD continue to show symptoms of the disease in adulthood. An employee who is unable to sit out until the end of the meeting and ignores important instructions, a talented specialist who disrupts important deadlines, suddenly being distracted by some personal project, an "irresponsible" partner who is unable to organize a home life or suddenly drains a lot of money on some strange whim - all of them can be not just weak-willed slobs, but people suffering from a mental disorder.

Diagnostic problems

According to various estimates, 7-10% of children and 4-6% of adults suffer from this disease. At the same time, the popular idea of an ADHD patient as an exclusively impulsive fidget is already outdated - modern science distinguishes three types of the disorder:

- with an emphasis on attention deficit (when a person does not have signs of hyperactivity, but it is difficult for him to concentrate, to work on the same task for a long time and to organize his actions, he is forgetful and easily tired)

- with an emphasis on hyperactivity (a person is overly active and impulsive, but does not experience significant difficulties with concentration)

- mixed version

According to the American DSM-5 Classifier of Mental Disorders, the diagnosis of attention deficit / hyperactivity disorder can be made no earlier than 12 years. In this case, the symptoms should be presented in different situations and settings and manifest themselves strongly enough to noticeably affect a person's life.

ADHD or bipolar disorder? One of the problems in diagnosing the syndrome is that, according to some signs, the syndrome overlaps with other mental illnesses - in particular, with cyclothymia and bipolar disorder: hyperactivity can be confused with hypomania, and fatigue and problems with concentration - with signs dysthymia and depression. In addition, these disorders are comorbid - that is, there is a fairly high probability of getting both at the same time. In addition, suspicious symptoms may be associated with non-mental illness (such as severe head injury or poisoning). Therefore, experts often recommend that those who suspect they have attention deficit disorder, before contacting psychiatrists, undergo a routine medical examination.

Gender nuances. Last year, The Atlantic published an article about how women show ADHD differently than men. According to the studies described in the article, women with this disorder are less likely to show impulsivity and hyperactivity, and more often - disorganization, forgetfulness, anxiety and introversion.

The T&P editors remind you that you should not completely rely on self-diagnosis - if you suspect you have ADHD, it makes sense to consult a specialist.

Loss of control

A genetic factor plays an important role in the development of ADHD - if your close relative suffers from this syndrome, the probability that you will be diagnosed with the same is 30%. Current theories link ADHD to functional impairments in the brain's neurotransmitter systems - in particular, to the balance of dopamine and norepinephrine. The dopamine and norepinephrine pathways are directly responsible for the executive functions of the brain - that is, for the ability to plan, by volitional effort to switch between different stimuli, flexibly change their behavior depending on changing environmental conditions and suppress automatic responses in favor of conscious decisions (this is what the Nobel laureate Daniel Kahneman calls "slow thinking"). All this helps us to control our behavior. Another function of dopamine is to maintain a “reward system” that controls behavior by responding to “correct” (in terms of survival) actions with pleasurable sensations. Disruptions in the work of this system affect motivation. In addition, people with attention deficit hyperactivity disorder may have abnormalities in serotonin balance. This can cause additional problems with organization, timing, concentration, and emotional control.

Personality disorder or personality trait?

Nowadays, the concept of neurodiversity is gaining popularity - an approach that considers different neurological features as the result of normal variations in the human genome. In the area of interest of adepts of neurodiversity - both sexual orientation and gender identity, and some genetically determined mental diseases, including autism, bipolar disorder and attention deficit disorder. Some scientists believe that many of the behaviors diagnosed with ADHD are natural personality traits that do not indicate the presence of unhealthy abnormalities. But since such traits make it difficult for a person to function in modern society, they are labeled as "disorder."

Psychotherapist Tom Hartman developed a spectacular "hunter-farmer" theory in which people with ADHD retained primitive genes for optimal hunter behavior. Over time, mankind moved to agriculture, which requires more patience, and "hunting" qualities - quick reaction, impulsiveness, susceptibility - began to be considered undesirable. According to this hypothesis, the problem lies only in the formulation of tasks, and the ability of people with the syndrome to "hyperfocus" - a strong concentration on a task that is subjectively interesting to them, to the detriment of everyone else - can also be viewed as an evolutionary advantage. However, it is difficult to consider Hartman an objective researcher - ADHD was diagnosed in his son.

But in any case, this theory has a healthy grain: since one of the most important criteria for mental health is the ability to successfully cope with everyday tasks, many problems can be ironed out by choosing the appropriate field of activity. That is, the one where routine processes and patience play a lesser role and the "sprint" temperament, the ability to improvise, curiosity and the ability to easily switch between various activities are valued. For example, it is believed that ADHD can have a good career in sales or entertainment, in the arts and in the "adrenaline" professions (say, firefighter, doctor, or military). You can also become an entrepreneur.

How to be treated

Medications: Psychostimulants containing amphetamine (Aderol or Dexedrine) or methylphenidate (Ritalin) are still used to treat ADHD. Drugs from other groups are also prescribed, for example, norepinephrine reuptake inhibitors (atomoxetine), hypotensive drugs (clonidine and guanfacine), and tricyclic antidepressants. The choice depends on the specific manifestations of ADHD, additional risks (addiction to drug addiction or concomitant mental disorders) and the desire to avoid certain side effects (an approximate list of "side effects" from different drugs can be found here)

Since in Russia psychostimulants have firmly settled in the list of dangerous drugs that are not available even with a prescription, domestic psychiatrists use atomoxetine, guanfacine or tricyclics.

Psychotherapy: Cognitive Behavioral Therapy is believed to help with ADHD, which, unlike many other schools of psychotherapy, places an emphasis on working with the mind rather than the subconscious. For a long time, this method has been successfully used in the fight against depression and anxiety disorder - and now there are special programs for the treatment of attention deficit disorder. The essence of such therapy is to develop awareness and not allow irrational patterns of behavior to take over a person's life. Classes help control impulses and emotions, deal with stress, plan and organize your actions, and get things done.

Nutrition and supplements. You can try to adjust your diet in accordance with the advice of foreign medicine. The most common recommendations are to take fish oil and avoid spikes in blood glucose (that is, say no to simple carbohydrates). There is also data showing the relationship between a lack of iron, iodine, magnesium and zinc in the body and an increase in symptoms. According to some studies, small servings of caffeine can help focus, but most experts still advise against eating too much coffee. Either way, adjusting your diet is more of a “supportive” measure than a full-fledged way of dealing with the disorder.

Schedule. People with ADHD, more than anyone else, require planning and a well-defined daily routine. The external backbone helps to compensate for internal problems with systematization and time management: timers, organizers and to-do-lists. Any large projects should be broken down into small tasks and planted in advance for rest periods and possible deviations from the schedule.