martes, 5 de junio de 2018

Is ADHD Linked to Other Mental Health Conditions?

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By Hardik Patel, M.Pharm.

Attention deficit hyperactivity disorder (ADHD) is a mental health condition affecting a huge number of children, adolescents and sometimes adults. The patients exhibit the symptoms of hyperactivity, inattention and impulsivity.

Overview of ADHD

Children with ADHD are usually seen to have difficulties in managing their emotions and organizing themselves. They tend to get into a trouble at school and elsewhere because of their inability to process information before reacting.

While being particularly common in children, the disorder is seen across all age groups except in geriatric individuals. ADHD affects people from all races and ethnicities equally.

Psychological wiring of the brain of an individual with ADHD is different from that of an unaffected individual. Imbalances in the levels of dopamine and norepinephrine in the brain are commonly seen in the patients with ADHD.

The frontostriatal circuit of the brains of ADHD patients has been the area of focus for several studies aiming to understand neural responses in ADHD patients.

Large scale trials with samples from diverse geographical populations are being carried out to understand the patterns of ADHD, its prognosis, and its association with other concurrent mental health conditions in a better manner.

Comorbidities

ADHD, just like any other neurological condition, is often associated with mental disorder comorbidity. More than 60% children with ADHD are reported to have one or more co-existing mental health conditions.

The typical challenge these comorbidities present is that their symptoms are often overlapping with those of ADHD. Because of this, oftentimes an accurate diagnosis becomes extremely complicated. The inaccuracy or delay in diagnosis can be a major concern affecting the mental health and quality of life of the patient.

A comprehensive evaluation of all the symptoms, medical history, and various psychometric tests help a psychiatrist to reach to a conclusive diagnosis of ADHD and any other comorbid conditions.

Commonly reported conditions co-existing with ADHD can be classified into three major categories:

Mood Disorders

Included under this umbrella are depression, anxiety, and bipolar disorder.

When children face difficulties in coping, especially when they face problems at school due to ADHD, they tend to feel extremely sad and hopeless. As such, ADHD patients face difficulties paying attention to things and organizing themselves, which are magnified when coupled with depression.

Approximately 10-15% of the children with ADHD suffer from comorbid depression. These patients often have suicidal inclinations due to lack of self-worth.

While worries and fears are normal elements of growth, an excessive amount of fear causes anxiety disorder in children. At least 20% children with ADHD suffer from one of the following types of anxiety disorder:

General anxiety disorder – Constant state of fearfulness about the future and things happening in life
Separation anxiety disorder – Excessive fear of being away from the family or a figure of attachment
Social anxiety disorder – Feeling of being constantly worried while meeting people and an inability to socialize

Some children with ADHD are also reported to have developed bipolar disorder. They experience mood swings characterized by periods of extreme happiness and extreme anger or irritation.

An early diagnosis of comorbid mood disorders is very crucial in the management of these conditions. Talking openly to the family members, and doctor of these patients can help a lot.

Psychiatrists often prefer cognitive behavioral therapy (CBT) for curing these ailments over antidepressant and anxiolytic medications in children.

Conduct Issues

Conduct disorder (CD): It is characterized by marked and unreasonable aggression. Patients with CD are likely to cause serious injuries to themselves and others. They tend to break rules and often damage others’ property on purpose. The diagnosis of ADHD in a child increases the likelihood of the diagnosis of CD.

Oppositional defiant disorder (ODD): ODD is characterized by persistent defiant behavior around known people such as family members, friends, and peers. Children with ODD often get angry, lose their temper, and behave disrespectfully. In extreme cases, they also tend to hurt individuals who they believe have hurt them.

Tourette syndrome: While relatively rare, this condition is generally accompanied by ADHD. Children with Tourette syndrome typically display repetitive mannerisms including blinking eyes, clearing throats and sniffing.

Around 25% of the children with ADHD are diagnosed with at least one behavioral/conduct related condition. As always, early treatment can work wonders.

Conduct and behavioral problems are usually handled by the behavioral training of parents,; thebehavioral treatment of the child, and sometimes medications.

Learning Problems

In addition to inattentiveness (a classic ADHD symptom), children with ADHD often suffer from other learning disabilities. These include dysgraphia (difficulty in writing), dyslexia (difficulty in identifying letters correctly), and dyscalculia (difficulty with processing numbers).

Co-existence of other mental health conditions with ADHD is statistically proven based on the available data. Scientists believe that stimulation of common physiological pathways and regions of the brain are responsible for comorbid neurological disorders.

Further research is indeed essential to pinpoint particular regions of the brain causing these comorbidities to arise and to develop targeted treatment approaches for these conditions.

Reviewed by Maryam Mahdi, BSc