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Attention Deficit Hyperactivity Disorder – ADD / ADHD

An Attention Deficit Hyperactivity Disorder is a complex neurodevelopmental condition, characterized by various symptoms linked to frontal lobe dysfunction or to their poor maturation. ADHD involves frequent and elevated levels of symptoms associated with inattention, hyperactivity and/or impulsivity. Present since childhood, this condition can impede and compromise the functioning of an individual who suffers from it, whether a child or an adult.

Symptoms of ADHD mainly take their root in the frontal lobes where cerebral activity is diminished (dopamine, noradrenalin), but also in deeper regions connected to the brain like the striatum, which is believed to function inefficiently. Frontal lobes are of a particular importance because they receive a high number of signals from various regions of the brain, and send many more back toward diffuse regions of the brain in order to ensure that cognitive resources are used efficiently. In fact, the frontal lobes can be likened to the maestro of an orchestra, whose role it is to manage each musician and to coordinate their effort as a whole; however, when the maestro is unable to keep up the pace, directing each element of the orchestra in unison becomes a difficult task and dissonance often ensues. Our brains work in a similar fashion when we consider that cognitive resources as well as the flow of information between various parts of the brain are mismanaged by the frontal lobes in ADHD.

Indeed, because attention is constantly being solicited in our daily lives, ADHD often disrupts the cognitive functioning of individuals in various spheres of life. For example, one can think of academic learning and university studies, which require good listening and observation skills as well as a stable concentration over long periods of time; of the importance of alertness and attention to detail to ensure safety and efficiency in the workplace; of the management of time, finance and resources, which require proper planning and organization skills; of social relations, interpersonal and family dynamics that can be destabilized by poor emotional control or impulsive behaviour; of eventual self-esteem problems in the face of emerging feelings of incompetence or unpopularity, etc.

Common manifestations of an Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is associated to a variety of symptoms, with some of the most frequently reported or observed listed below:

  • Academic difficulties, including reading comprehension and problem solving
  • Difficulty following directives or instructions
  • Unable to complete complex tasks requiring different steps
  • Forgets or loses his belongings
  • Requires reminders or repetition of information
  • Poor awareness of time
  • Agitation, overtly active, needs to move or to manipulate objects
  • Unable to finish tasks, often changes activity and seeks stimulation
  • Interrupts people, acts suddenly and impulsively
  • Talks a lot, jumps from one subject to another
  • Irritable and can give into anger
  • Trouble following conversations in crowded spaces
  • Social difficulties due to improper behaviour or withdrawal
  • Daydreams, has trouble concentrating
  • Easily distracted, inefficient, procrastinates
  • Often late or last minute
  • Takes longer than expected to complete homework or exams
  • Trouble completing two tasks at the same time
  • Disorganized, has trouble remaining structured
  • Poor planing, has trouble estimating time or effort required for a task
  • Easily discouraged, gives up in the face of obstacles
  • Low self-esteem
  • Risk behaviour in adolescents-adults

ADHD SUBTYPES

ADHD is a neurological disorder induced by alterations in the brain’s frontal lobe development; as such, some hyperactive or inattentive symptoms must have been present during childhood, before the age of 7. For these reasons, ADHD cannot suddenly appear during adulthood, and this is a fundamental criteria to its diagnosis.

The DSM-V classifies ADHD into three different subtypes: the inattentive, hyperactive-impulsive and mixed subtypes. A fourth subtype, Sluggish Cognitive Tempo, is progressively being mentioned in the literature, but has not yet been officially recognized.

1) An ADHD of the predominantly inattentive type (ADD) is recognized in people presenting with the following behaviours (six criteria for children, five for adults):

  • fails to pay close attention to details or makes careless mistakes in schoolwork, work or other activities
  • has difficulty sustaining attention in tasks or play activities
  • does not seem to listen when spoken to directly
  • has difficulty organizing tasks or activities
  • does not follow through on instructions and fails to finish school work, chores or duties in the work place
  • loses things necessary for tasks or activities
  • forgetful in daily activities
  • easily distracted by extraneous stimuli

2) An ADHD of the predominantly hyperactive-impulsive subtype (ADHD) is recognized in people presenting with the following behaviours (six criteria for children, five for adults):

  • fidgets with hands or squirms in seat
  • leaves seat in classroom or in other situations in which remaining seated is expected
  • runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless)
  • unable to play or take part in leisure activities quietly
  • often “on the go” acting as if “driven by a motor”
  • talks excessively
  • blurts out an answer before a question has been completed
  • has trouble waiting his/her turn
  • interrupts or intrudes on others

3) An ADHD of the predominantly mixed subtype is recognized in people presenting with a mixture of inattention and hyperactivity-impulsivity if:

  • six criteria for the inattentive subtype and six criteria for hyperactive-impulsive subtype are present in a child
  • five criteria for the inattentive subtype and five criteria for the hyperactive-impulsive subtype are present in an adult

THE CONTRIBUTION OF NEUROPSYCHOLOGY

It is not always easy to recognize an Attention Deficit Hyperactivity Disorder, because ADHD shares many symptoms with other affectations such as depression, anxiety, autism spectrum disorder, dysphasia, non-verbal learning disability, intellectual disability, giftedness, head trauma, Tourette Syndrome and more. Many of these conditions can give the impression that a person presents with inattention, with difficulty concentrating or even impulsivity, but without an accurate and thorough assessment, misdiagnoses are often issued. On other occasions, milder forms of predominantly inattentive ADHD can sometimes pass under the radar.

The neuropsychological assessment therefore allows to differentiate an individual’s strengths from his weaknesses, so as to help establish where his difficulties stem from. By assessing all aspects of cognitive functioning (attention, memory, language, learning, executive functioning, motor function, perception, intelligence, abstract thinking, reasoning, etc.), the neuropsychologist will be able to rule out different conditions or hypotheses, while narrowing down and identifying specific difficulties linked to ADHD.

An accurate diagnosis of ADHD and a detailed picture of the strengths and weaknesses of an individual will help generate solutions, able to guide them towards a better functioning and quality of life.

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