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Is adhd a behavioral disorder


Is ADHD a Cognitive Disorder or Behavioral Disorder?

As an attention deficit hyperactivity disorder (ADHD) researcher, a clinical professor of psychiatry at the Yale University School of Medicine, the author of Attention Deficit Disorder: The Unfocused Mind in Children and Adults, and as a psychologist helping patients manage their symptoms and reclaim their lives, I have seen ADHD from all sides.

My research into the brain has posited a new model for ADHD. The old model thinks of ADHD as a behavioral disorder. Many adults and children living with ADHD never have had significant behavior problems; they have difficulty focusing their attention on necessary tasks and using working memory effectively, making ADHD a cognitive disorder, a developmental impairment of executive functions (EFs) — the self-management system of the brain.

My theory of executive function impairment, or executive function disorder (EFD) has been slow to filter down to family doctors who are making diagnoses and prescribing medication. Too many doctors still think about ADHD in the old way — as a behavior problem accompanied by difficulty in paying attention. They don’t understand that “executive function” is really a broad umbrella. When patients hear the symptoms associated with EFD — finding it hard to get organized or to start tasks, to sustain effort to finish tasks, to hold off instead of jumping impulsively into things, to remember what was just read or heard, to manage emotions — they’ll say, “Yeah, yeah, yeah, that’s me.” A lot of executive function impairment goes beyond the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria for ADHD.

We need to better understand the individual variants of ADHD in adults. Some adults have big problems in school, but once they get out of school, they are able to specialize in something that they’re good at, or take a job where an assistant helps them manage the day-to-day minutia, and they do fine. Other adults manage through school, but they don’t do well at jobs or managing a household. We’re beginning to identify the domains of impairment and to recognize that these difficulties with executive functions not only affect people with academic tasks but also in their ability to maintain social relationships and to manage emotions.

The following six clusters of executive functions tend to be impaired in individuals with ADHD:

Activation: organizing tasks and materials, estimating time, getting started.
Focus: focusing, sustaining focus, and shifting focus between tasks.
Effort: regulating alertness, sustaining effort and processing speed.
Emotion: managing frustration and modulating emotions.
Memory: using working memory and accessing recall.
Action: monitoring/ regulating actions.

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ADHD and behavioral disorders: Assessment, management, and an update from DSM-5

Review

. 2015 Nov;82(11 Suppl 1):S2-7.

doi: 10.3949/ccjm.82.s1.01.

Joseph Austerman  1

Affiliations

Affiliation

  • 1 Center for Pediatric Behavioral Health, Cleveland Clinic Children's, Cleveland, OH, USA. E-mail: [email protected].
  • PMID: 26555810
  • DOI: 10.3949/ccjm.82.s1.01

Free article

Review

Joseph Austerman. Cleve Clin J Med. 2015 Nov.

Free article

. 2015 Nov;82(11 Suppl 1):S2-7.

doi: 10.3949/ccjm.82.s1.01.

Author

Joseph Austerman  1

Affiliation

  • 1 Center for Pediatric Behavioral Health, Cleveland Clinic Children's, Cleveland, OH, USA. E-mail: [email protected].
  • PMID: 26555810
  • DOI: 10.3949/ccjm.82.s1.01

Abstract

Behavioral disorders in pediatric patients--primarily attention deficit hyperactivity disorder (ADHD)--pose a clinical challenge for health care providers to accurately assess, diagnose, and treat. In 2013, updated diagnostic criteria for behavioral disorders were published, including ADHD and a new diagnostic entity: disruptive mood dysregulation disorder. Revised criteria for ADHD includes oldest age for occurrence of symptoms, need for symptoms to be present in more than one setting, and requirement for number of symptoms in those aged 17 and older. Assessment of ADHD relies primarily on the clinical interview, including the medical and social history, along with the aid of objective measures. The clinical course of ADHD is chronic with symptom onset occurring well before adolescence. Most patients have symptoms that continue into adolescence, and some into adulthood. Many patients with ADHD have comorbid disorders such as depression, disruptive behavior disorders, or substance abuse, which need to be addressed first in the treatment plan. Treatment of ADHD relies on a combination of psychopharmacologic, academic, and behavioral interventions, which produce response rates up to 80%.

Copyright © 2015 Cleveland Clinic.

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ADHD in adults - treatment, symptoms, diagnosis

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Treatment of ADHD in adults

Rehabilitation clinic "A NEW DAY" specializes in the treatment of adults with ADHD. We have developed and effectively applied a set of rehabilitation measures for ADHD.

Individual approach

Each patient has his own doctor - a neurologist. He knows everything about the patient and his disease, if necessary, he can make adjustments to the course of treatment at any stage. The main thing is the result. At the end of the course of treatment, individually developed recommendations are issued. nine0006

Treatment is always a complex

Taking into account the variant of the course, the age of the patient, the severity of manifestations, the most appropriate methods and their combinations are selected: (BOS).

In everyday life, ADHD patients are not recommended to engage in those sports that involve a competitive nature and have a pronounced emotional component, for example, martial arts, team games. Useful jogging, swimming (non-competitive), cycling, skiing. nine0003

To improve the psychological and emotional state, reduce anxiety, overcome depression, sleep disorders, various methods of psychotherapy are used. The choice of a technique suitable for a particular patient is carried out by a psychologist or psychotherapist.

Relaxation techniques: special relaxation massages, relaxation sessions, medical treatment.
Cognitive training is used for attention deficit. Acupuncture (IRT) is traditionally used to restore the regulation of many organs, including the brain. nine0006

Innovative techniques

Translingual neurostimulation (TLNS) is an effect on the brain through the stimulation of tongue receptors. This is an advanced innovative technique, most effectively used in the treatment of diseases of the central nervous system, and as we know, ADHD belongs to such diseases. The use of TLNS allows you to restore the regulation of excitation-inhibition processes in a short time, which ultimately leads to an improvement in the course of ADHD, the best psychological and motor correction. In addition, TLNS has a positive effect on cognitive functions, such as concentration and memory, improves sleep, allowing the body to restore its neurotransmitter stores and have a good rest. nine0006

Continuity and recurrence

ADHD has a favorable course when properly treated. It is important to maintain the results achieved. To do this, at discharge, we give detailed individually developed recommendations. As long as there is any residual symptomatology, courses of treatment should be repeated, as a rule, 2-3 times a year.

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Attention deficit disorder in adults

ADHD is a childhood-onset neurological behavioral disorder characterized by difficulty concentrating and maintaining attention, excessive motor activity (hyperactivity) and incontinence (impulsivity).

In recent years, the frequency of ADHD has increased, including among adults. It used to be thought that by adolescence, the symptoms of ADHD would significantly improve or go away. However, now these ideas have changed: in 30-70% of cases, ADHD persists into adulthood. Most often this is due to insufficiently effective treatment in childhood. nine0006


More about ADHD

All processes occurring in the nervous system are based on two oppositely directed mechanisms: excitation and inhibition. Normally they are balanced. However, the formation of the nervous system does not occur immediately after birth. The brain is mainly formed before the age of 8 years, but finally only by the age of 25. Therefore, in children, arousal and inhibition often get out of control, in some cases leading to ADHD. Over time, the brain matures and the symptoms of ADHD improve or go away on their own. But even in an adult, cognitive, behavioral, and motor
disorders resulting from ADHD. That is why the prevalence of ADHD in adults, although it has increased in recent years, still remains much less than in children.

In general, the manifestations in children and adults do not differ, but there are features.

First, if a child does not have ADHD, then an adult will not develop this disease. Therefore, ADHD in adults is not a separate disease, but disorders that have persisted since childhood.

Secondly, in adults, attention disorders prevail over manifestations of hyperactivity. It is difficult for such people to concentrate and maintain attention, so many activities that require concentration may not be available to them. Hyperactivity can be manifested by restlessness, so sedentary sedentary work is not suitable for them. nine0006 Impulsivity can be manifested by conflicts in the family and at work.

And thirdly, the presence of ADHD in adulthood requires careful examination to exclude other disorders, incl. mental illness.

Manifestations of ADHD depend on the course of the disease.

Types of ADHD in adults

  • With a predominance of impaired (deficit) attention

  • With a predominance of hyperactivity

  • Mixed version of ADHD

Symptoms of ADHD in adults

Symptoms of inattention (in at least 5 symptoms for at least 6 months):

  • Inability to concentrate on details, errors of incorrect
  • Inability to hold attention for a long time
  • Often one gets the impression that he does not listen to spoken speech
  • Inability to follow instructions, algorithms, for example, to fulfill conditions tasks
  • Resistance to getting involved in tasks, avoiding or active resistance
  • Frequent loss of things, especially those necessary to complete tasks
  • Easy distractibility to extraneous stimuli or thoughts (“hovering” in thoughts)
  • Routine forgetfulness (errands, chores, being late)


Symptoms of hyperactivity (in adults, at least 5 symptoms for at least 6 months):

  • Constant movements in the hands, feet, fidgeting in a chair
  • Getting up from a place
  • Inability to sit still
  • Inability to pass time calmly
  • Constantly in motion, as if “wound9”, as if “attached a motor” 908088
  • Answers a question without listening to the question itself
  • Difficulty waiting in line
  • permissions. nine0088

These symptoms must reach a degree of severity that interferes with learning, communication, work. They should be observed both at home and in other places (at work, at a party, etc.). They should be noticed not only by relatives, but also by those around them.

    An additional examination may be required to clarify the diagnosis and exclude other diseases that have similar symptoms:

    • EEG (electroencephalography)
    • Doppler ultrasonography0088
    • Evoked potential (EP) method
    • Psychotherapist's consultation
    • Brain MRI
    • Psychiatrist's consultation (if indicated)

    )
    – ADHD CR (expanded complex)
    – Cognition CS (standard complex)
    – Cognition CR (expanded complex)

    – Psychotherapy ind. COP (complex standard)
    – Psychotherapy ind. CR (advanced complex)

    Comparative table of all programs

    causes, symptoms, signs, diagnosis, treatment of attention deficit hyperactivity disorder in children and adults

    ADHD symptoms in children

    Causes of pathology

    Diagnosis

    Treatment methods ADHD

    Prevention


    Today, more and more children are being diagnosed with ADHD (Attention Deficit Hyperactivity Disorder). As a rule, it is diagnosed in children aged 6-8 years, when the child goes to school. It is at this time that it becomes obvious that the child has pronounced problems with behavior and perception of information. nine0003

    ADHD is a neurological-behavioral developmental disorder. Pathology makes itself felt in childhood, but in the absence of timely therapy, it can persist into adulthood. According to statistics, ADHD is most common in boys, but can also occur in girls. If the pathology is not diagnosed and treated in a timely manner, this is fraught with poor school performance, the child may develop serious social problems, which increases the risk of substance abuse in the future. nine0003

    Symptoms of ADHD in children

    Consider some of the signs that may signal ADHD in children:

    • The child is constantly distracted, inattentive, when communicating with him there is a feeling that he is not listening to you.
    • It is difficult for him to keep his attention on the teacher's words for a long time, because of which the understanding of information also suffers.
    • Increased activity is observed - the child literally cannot sit in one place. Even during school hours, he can get up and walk around the classroom. nine0088
    • The child is impatient, cannot wait for his turn, constantly interrupts, answers questions without waiting for them to end.
    • Children with ADHD are characterized by emotional instability, which can be manifested by frequent mood swings: a child can suddenly become irritable, tearful, and restless for no reason.
    • Lack of concentration is typical - children with this diagnosis often lose their belongings (for example, school supplies, money, keys).
      • nine0084 Problems with sleep and appetite, with daily routine.

    Additionally, some neurological abnormalities may be observed. For example, a child with ADHD may have poor motor coordination, resulting in some clumsiness. Also, in some cases, twitching of the facial muscles and trembling of the limbs are observed.

    The first signs of attention deficit hyperactivity disorder are observed at the age of 2-3 years, but at this age it is difficult to determine whether they are a manifestation of pathology or normal age-related features. nine0003

    However, if by the age of 6-8 years the child has not become more attentive and collected, this is an alarming sign that makes it possible to assume ADHD with a high degree of probability. That is why, if you have the above symptoms, you should definitely consult a doctor and start treatment.

    Causes of pathology

    There is no single reason for the development of ADHD. Many experts agree that the most common cause may be genetic mutations that lead to a disruption in the production of dopamine and the work of dopamine receptors. nine0003

    Also, the causes of the development of attention deficit hyperactivity disorder may be the following factors:

    • Severe pregnancy, complicated delivery, including prolonged or rapid.
    • Use by the expectant mother during pregnancy of potent drugs, alcoholic beverages, toxic substances.
    • Serious pathologies suffered by a child at an early age, including craniocerebral trauma. nine0088
    • Psychological trauma in a child.
    • Fetal asphyxia.

    It is also worth noting that this pathology has a hereditary predisposition. It was found that the presence of ADHD in parents significantly increases the likelihood of developing this syndrome in a child.

    Diagnostics

    The diagnosis of ADHD is not established only on the basis of existing complaints. To accurately confirm the diagnosis, it is necessary to conduct some examinations. First of all, you need to visit a neurologist, psychiatrist and psychologist. nine0003

    During the consultation, the doctor collects an anamnesis, conducts various tests, conversations, and diagnostic surveys.

    In order to identify the cause of the development of ADHD, consultations with other specialists may also be required, as well as instrumental and laboratory examination methods, such as: EEG, MRI of the brain, general and biochemical blood tests.

    ADHD treatments

    It should be noted that attention deficit hyperactivity disorder most often has a favorable prognosis (provided that therapy is started in a timely manner). It is possible to significantly improve the behavior and learning of the child. nine0003

    Depending on the severity of the pathological process and the causes of its occurrence, the doctor may prescribe such types of treatment as:

    • Medical treatment: the patient may be prescribed sedatives, antidepressants, neurostimulants.
    • Cognitive behavioral therapy.
    • A clear daily routine: a balanced diet, good sleep.
    • Family therapy: if there are conflicts in the family, ADHD often develops against this background. nine0088
    • Biofeedback therapy: this method of treatment is aimed at training the child's ability to self-regulate their states with the help of computer game tasks.
    • Physiotherapy techniques, eg massage, exercise, kinesiotherapy.

    Additionally, other methods of treatment can be used.

    Prophylaxis

    Unfortunately, it is not always possible to prevent the development of ADHD. However, there are some factors that significantly reduce the risk of developing pathology. For example, the expectant mother should follow a healthy lifestyle, eat a balanced diet, give up bad habits. Before conception, it is desirable to undergo a complete examination, if necessary, to pre-treat existing pathologies. nine0003

    Also, as a prevention of ADHD, the following recommendations should be observed:

    • The child should be active, walk outdoors more often.
    • The regime of the day and nutrition should be clear.
    • Monitor the child's behavior, immediately stop unacceptable behavior on his part.
    • It is very important to build a trusting relationship between parents and children.
    • Family conflicts should be avoided. nine0088

    At the first signs of ADHD, it is recommended to contact specialists who will help minimize the risk of developing more serious pathologies in the future.

    You can learn more about the treatment of attention deficit hyperactivity disorder at a face-to-face appointment with a doctor. Be healthy!


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    Markelov Gleb Vladimirovich

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