Attention Deficit Hyperactivity Disorder (ADHD), in the past two decades, clinical doctors and researchers have utilized various methods to further understand the symptoms and etiology of ADHD. Despite the increasing body of literature on the pathophysiology of this disorder, ADHD remains a complex psychiatric condition. It affects the neurosystem of children, and its symptoms may persist into adulthood.
Children with this condition exhibit hyperactivity, inattention, impulsivity, as well as issues in social and academic performance. If left untreated, it may lead to destructive long-term consequences. Research suggests that untreated children perform worse in academics, occupational, and social functioning compared to treated individuals, and they may develop antisocial behaviors. Encouraging proactive treatment and behavioral interventions is crucial for effectively improving the long-term development of patients.
What is Attention-Deficit/Hyperactivity Disorder (ADHD)?
Attention-Deficit/Hyperactivity Disorder (ADHD) is a commonly occurring and persistent mental disorder that manifests in early childhood. Currently, it is estimated to affect 5% of children aged 4-17. The hallmark features of this disorder include symptoms of inattention, impulsivity, and hyperactivity. ADHD is typically recognized and diagnosed during the school-age years. This condition impacts approximately 8-12% of children globally. While the prevalence of ADHD decreases with age, at least half of the children diagnosed with the disorder continue to experience adverse effects into adulthood.
Moreover, many children diagnosed with ADHD continue to face educational, social, or other mental health-related challenges during adolescence, highlighting the long-term impact of this disorder.”
The causes of ADHD in children include:
Genetic Inheritance:
There is strong evidence from family and twin studies that ADHD has a significant genetic component. Molecular genetic research has indicated that the genetic structure of ADHD is complex, and comprehensive results from whole-genome scans have not yet been obtained. Several genes have been associated with ADHD, including DRD4, DRD5, DAT, DBH, 5-HTT, HTR1B, and SNAP-25. Research has found that the heritability of ADHD can reach 70-80%. If a sibling has ADHD, the likelihood of the individual having it may be 3-4 times that of the general population.
Environmental Factors:
Some studies suggest that environmental factors may be more influential in children and adolescent psychopathology than genetic factors. Brain injuries, exposure to environmental factors during pregnancy or early life (such as lead exposure), maternal alcohol and tobacco use during pregnancy, premature birth, low birth weight, and other factors have been linked to the development of the disorder. Excessive sugar consumption, excessive television watching, and factors related to parenting style, family relationships, and social and environmental influences can worsen the symptoms of ADHD.
ADHD symptoms in hyperactive children include the following:
Children with attention deficit hyperactivity disorder (ADHD) continue to grow up in a state where they cannot concentrate. If the symptoms persist over a long period, they may become more severe and cause difficulties in school, at home, or when interacting with friends. Generally, children with ADHD may exhibit the following symptoms: daydreaming frequently, forgetting or losing things, being restless, talking excessively, being prone to careless mistakes or unnecessary risks, finding it difficult to resist temptations, and struggling with social interactions. Since the symptoms can change over time, their presentation may also vary.[7]
There are primarily three different types [7] [9]:
1.Predominantly Inattentive Presentation (ADD):
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- Often can’t pay close attention to details and is prone to careless mistakes (during school, work, or other activities).
- Has difficulty sustaining attention during tasks or play.
- Often appears as if not listening when spoken to directly.
- Frequently can’t follow instructions and fails to complete schoolwork, household duties, or workplace responsibilities.
- Often has difficulty with task organization.
- Frequently avoids, dislikes, or is reluctant to engage in tasks requiring sustained mental effort.
- Often loses things necessary for tasks or activities.
- Often easily distracted by external stimuli.
- Frequently forgets daily activities and is forgetful in daily life.
2.Predominantly Hyperactive/Impulsive Presentation (HD):
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- Often fidgets with or taps hands or feet or squirms in seat.
- Often leaves the seat when remaining seated is expected.
- Often runs or climbs in inappropriate places (Note: In adolescents and adults, may only feel restless).
- Often unable to engage in leisure activities quietly.
- Often acts as if driven by a motor and is always on the go.
- Often talks excessively.
- Often blurts out answers before questions have been completed.
- Often struggles with waiting their turn.
- Often interrupts or intrudes on others’ activities.
3.Combined Presentation (ADHD):
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- Both of the above symptoms are present in an individual.
The clinical course of ADHD is chronic, with symptoms often appearing before adolescence. Most patients will continue to experience symptoms into adolescence, and some may persist into adulthood. Many individuals with ADHD have comorbid disorders, such as depression, disruptive behavior disorders, or substance abuse, which need to be addressed as part of the treatment plan [8].
Diagnosing ADHD (Attention-Deficit/Hyperactivity Disorder) typically involves a thorough assessment because many other conditions can present with similar symptoms, such as anxiety, depression, sleep issues, and certain types of learning disorders [7]. According to guidelines provided by the Department of Health and Human Services, the diagnosis of ADHD can be made using the following criteria [9]:
- Predominantly Inattentive Presentation:
- Six or more inattentive symptoms present for at least six months.
- Predominantly Hyperactive/Impulsive Presentation:
- Six or more hyperactive/impulsive symptoms present for at least six months, with inattention symptoms being fewer than six but still clinically significant.
- Combined Presentation (Inattentive and Hyperactive/Impulsive):
- Six or more symptoms of inattention and six or more symptoms of hyperactivity/impulsivity present for at least six months.
How should ADHD hyperactive children be treated?
Most children and adolescents with ADHD fall into the combined presentation category.
1. Medication Therapy:
- Stimulant medications are often used to effectively reduce ADHD symptoms in the short term. They are commonly considered the first-line treatment option for school-age children, adolescents, and adults [10].
- Non-stimulant medications may not work as quickly as stimulant medications, but their effects can last up to 24 hours [9].
2. Behavioral Therapy:
- Developing an appropriate behavioral treatment plan in collaboration with a physician is crucial. Early intervention is important, and when parents and teachers work together to help the child, it is often the most effective approach.
- Behavioral therapy may include child behavior therapy, emotional management therapy, and other interventions aimed at strengthening appropriate behavior and correcting inappropriate behavior. Parental behavior management training can help children develop suitable behavior, improve communication, and learn how to manage their emotions[7] [9] [12].
3. Nutritional Supplements to Aid Improvement:
- Supplements containing polyunsaturated fatty acids Omega-3, zinc (Zn), iron (Fe), and magnesium (Mg) are considered useful in the treatment and improvement of ADHD. An increasing body of research suggests that Omega-3 supplements, in particular, may reduce the dosage of medications needed for ADHD treatment [13].
- Studies on children with ADHD indicate that supplementing Omega-3 polyunsaturated fatty acids can improve certain symptoms and behaviors[14].
The choice of treatment should be based on the individual patient’s specific condition and symptoms and should be developed in consultation with a healthcare provider or mental health professional.
In one clinical study, young individuals (aged 6-18) with attention deficit hyperactivity disorder (ADHD) were given high-dose eicosapentaenoic acid (EPA) supplements, 1.2 grams daily, continuously for 12 weeks. The results showed significant improvements in their ability to concentrate, and they exhibited fewer impulsivity symptoms. Additionally, it was found that young individuals with initially lower EPA levels in their bodies experienced more pronounced improvements in attention when given high-dose EPA [15].
In another study, patients were supplemented with 650 milligrams of EPA and 640 milligrams of docosahexaenoic acid (DHA) daily for 16 weeks. The results indicated a reduction in ADHD symptoms, suggesting it as an adjunct treatment for ADHD [16]. Furthermore, in a clinical study involving children with ADHD, daily supplementation of 10.8 grams of EPA and 5.4 grams of DHA for four weeks led to significant improvements in behavior (inattention, hyperactivity, oppositional/defiant behavior, and conduct problems) based on interviews with a psychiatrist [17].
A study involving 23 children with attention deficit hyperactivity disorder (ADHD) and abnormally low serum ferritin levels found that daily supplementation with 80 mg of ferrous sulfate resulted in significant improvement in ADHD symptoms [18]. In comparison to iron supplements, a study with 400 children with ADHD found that daily supplementation with 150 mg of zinc sulfate led to improvements in hyperactivity, impulsivity, and social interaction difficulties [19].
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