ADHD - everything you need to know
Attention Deficit and Hyperactivity Impulsivity Disorder (ADHD), is essentially a complex disorder consisting of at least two disorders:
- Combined Attention Deficit with Hyperactivity and Impulsivity Disorder, defined as Attention Deficit and Hyperactivity Disorder (ADHD).
- "Pure" Attention Deficit Disorder, defined as Attention Deficit Disorder (ADD).
Attention Deficit and Concentration Disorder is composed of an organic core, around which layers of psychological and social reactions develop over the years, ultimately forming the complete structure of the disorder. This development can be compared to the formation of a pearl, where the grain of sand that penetrates the personal shell is the organic basis of the disorder, that is, the inherent tendency. Interactions with other parts of the self and the environment occur around it until the final pearl is formed. From this perspective, just as no two pearls are identical, no two cases of attention disorders are identical. Attention Disorder, even if its "organic intensity" is the same in two children, will manifest differently in each of them based on their other characteristics and the surrounding environment.
It is assumed that attention disorder is essentially a predisposition. The predisposition itself is based on the ability to simultaneously perceive multiple stimuli and relate to them equally. Therefore, isolating a single stimulus and focusing solely on it while ignoring other stimuli is not possible. This characteristic makes it very difficult for the individual to sit in class for an extended period and listen to the teacher, while blocking out all other surrounding stimuli. It also makes it challenging for the individual to engage in monotonic or single-stimulus activities, such as reading a book or sitting passively in front of a lecturer, all of which require focused attention on one stimulus while filtering out surrounding stimuli. In situations where there are many stimuli, a central stimulus (such as a television or computer screen), or even a high level of interest, circumvents the difficulty in attention and allows concentration. Furthermore, in any situation with multiple stimuli, the individual with attention disorder has an advantage over those around them who do not possess this trait.
Therefore, attention disorder, even with the development of its accompanying components, is a disorder that is very close to the normal functioning of the child, but it can still cause significant distress to the child and their environment. This combination is what makes this disorder so challenging, both for diagnosis and treatment.
Attention Deficit and Concentration Disorder is a common phenomenon that exists in approximately 5-10% of school-age children, aged 7-12. The prevalence of this phenomenon is three times higher in boys than in girls, primarily in cases characterized by excessive motor activity and restlessness. In contrast, Attention Disorder appears equally in boys and girls, especially in older age groups.
The disorder manifests as disturbances in concentration and attention, impulsivity, and sometimes excessive activity. In some children, behavioral problems are also present. In a significant portion of children (80%), the symptoms persist into adolescence and adulthood.
Early detection and intervention are of great importance due to the potential damage to academic achievements and social and psycho-developmental areas. The central problem in terms of behavior is the lack of consideration for impulsive behavioral reactions. As awareness of this situation has increased, most students are diagnosed before reaching middle school or high school. However, in the early grades of elementary school (grades 1-4), a significant percentage of children with undiagnosed ADHD still exist. This is particularly true for students suffering from attention deficit and concentration disorder without hyperactivity, especially those with high intellectual abilities that enable them to relatively cope with their limitation as long as they are in lower grades. Nevertheless, the absence of diagnosis can lead to emotional, social, and behavioral secondary effects.
ADHD is a result of a combination of genetic causes, which are highly influential, environmental (both prenatal and postnatal), and cultural factors, with varying significance.
Environmental factors can include maternal substance use or heavy smoking during pregnancy, maternal diabetes during pregnancy, and malnutrition. Family genetic background is also a significant factor in many cases, and it is now widely accepted to view ADHD as an organic and behavioral disorder.
Genetic factors are thought to contribute significantly to ADHD. The development of attention deficit and concentration disorder is believed to be the result of a combination of biological and psychosocial factors that shape a common final syndrome. The underlying disorder is organic, based on a slight change in brain structure and function. Various imaging studies have linked the disorder to structural differences in the prefrontal cortex, particularly the right prefrontal cortex, and have focused on the fronto-striatal circuit. Studies examining brain function have revealed a relative decrease in the utilization of glucose and oxygen in these brain areas during tasks that require concentration.
The main neurotransmitter involved is dopamine, while serotonin and norepinephrine are also mentioned. Research into medication use has found that the influence is not specific, and the response to medications like Ritalin differs between individuals with and without ADHD.
Genetic research has found that ADHD "runs in families" with a high intergenerational transfer rate, estimated at around 75-80%. Family studies indicate that ADHD is a hereditary family disorder. Adoption studies significantly support the genetic basis of attention and concentration problems and suggest a higher percentage of children with attention problems in biological parents compared to adoptive parents.
It appears that changes exist in several genetic polymorphisms, mainly in genes encoding neurotransmitters dopamine and serotonin, and these changes cause various alterations in the structures of the proteins that transport and receive them in the brain. The main polymorphisms mentioned today are:
- DRD4 (Dopamine receptor 4)
- DAT-1 (Dopamine transporter)
- 5-HTTLPR (Serotonin transporter)
In other words, attention deficit disorder is based on functional changes in brain neurotransmitters, primarily dopamine, which has been associated with less efficient transmission and uptake during intercellular transfer.
Attention and concentration problems, or professionally named ADHD, arise from a neurological disorder in the nervous system, which can manifest in various ways in children. In some cases, the disorder is expressed more in hyperactivity and difficulty sitting quietly and learning. In others, it may lead to "daydreaming" and social isolation. Sometimes, these children might be very talented and not realize they are struggling, finding ways to compensate for the difficulties, which can lead parents to overlook the problem. Others may struggle significantly in their studies, creating an academic gap with their peers that may grow over the years.
At a young age, before entering school, attention and concentration disorder is characterized by restlessness, lack of discipline, severe outbursts of crying and anger, and at times, a lack of willingness and ability to perform complete tasks. Lack of focus, difficulty obeying rules including game rules, and sometimes excessive motor activity can also be observed. Young children may not be aware of dangers to themselves or others, and they may climb dangerous heights or run onto roads without recognizing the risks.
During elementary school years, symptoms of the disorder manifest in impulsivity, anger outbursts, and a tendency to withdraw. As they often provoke anger from other children and adults, they may become socially isolated and develop antisocial tendencies, at times even becoming violent.
In elementary school, the disorder is evident in lower-than-expected achievements, difficulties with organization, and homework preparation. As adolescents and adults, they struggle with studies, have difficulty finding and maintaining jobs that match their skills and expectations, and struggle with obeying rules. They may become aggressive and prone to substance abuse, smoking, alcohol, and engage in illegal and dangerous activities both for themselves and society. They are more noticeably involved in various accidents, including traffic accidents.
Many symptoms of attention and concentration disorders are highly prevalent in the general population, especially among children. In the diagnostic process of attention and concentration disorders, several symptoms present in the child are examined, including their frequency, intensity, and disruption to daily life. To determine whether a professional diagnosis is warranted, it's important to be attentive to the most significant warning signs that may indicate the presence of a neurological disorder. These warning signs begin to "flash" relatively early, typically when the child is in kindergarten or first grade. Prominent symptoms include:
Key Clinical Symptoms of Attention and Concentration Problems
- Concentration Difficulties – If you're talking to a child and they struggle to maintain their attention over time, if they don't respond when you call their name and speak directly to them, this is definitely a significant sign of difficulty that should be taken into consideration.
- Task Avoidance or Procrastination – One prominent sign of attention and concentration disorders is difficulty in performing "boring" tasks that hold no significant interest. These tasks might include studying for a test, doing homework, or anything else the child is not motivated to do. On the other hand, in subjects that interest them, they may become deeply engrossed and invest a significant amount of time, sometimes excessively. Additionally, there may be rapid switching from one task to another, without completing any of them. On the flip side, there may be obsessive involvement in specific topics the child is highly interested in.
- Problems with Order and Organization – Difficulty maintaining order is a prominent sign of attention and concentration disorders. Those who suffer from this phenomenon may also lose more items and waste a lot of time searching for their belongings.
- Memory Problems – Another significant sign of attention and concentration disorders is significant difficulty in remembering vital, basic, and daily information.
- Restlessness and Lack of Quiet – Hyperactivity and impulsivity are significant aspects of attention and concentration disorders. These phenomena can manifest as excessive hand and foot movements, incessant talking, difficulty sitting for extended periods, impatience, and a tendency to interrupt others or cut them off while speaking.
- Daydreaming and "Spacing Out" – Attention and concentration disorders are also associated with a tendency to daydream during wakefulness and become absorbed in sudden thoughts. Such children are sometimes referred to as "astronauts" or "floaters."
It should be noted that this is only a partial list of symptoms – and many of these symptoms are highly prevalent among children, adolescents, and adults. Therefore, these symptoms do not necessarily indicate attention and concentration disorders. Additionally, as mentioned, it encompasses a range of states that many people may identify with or observe in their children. Above all, this is a directional reading that will help you understand whether it's time to seek comprehensive and professional diagnosis to better recognize the challenges accompanying the child.
Course of Attention Deficit Disorder
The course of attention deficit disorder is inherent, meaning it accompanies an individual throughout their life, from its beginning to its end. It exhibits various expressions at different ages, depending on the individual's characteristics and the surrounding environment.
During early childhood, there are few distinctive expressions, including delayed acquisition of full night sleep until a relatively late age (around one year), early motor skills development and relatively early onset of walking. In some children, more advanced motor skills can already be observed in early childhood. However, many children reach school age without any suspicion of the presence of this characteristic in them. In school age, the prominent manifestation of difficulties begins, leading to referrals of these children to diagnostic and therapeutic frameworks.
Describing the world from the perspective of such a child, one sees a frustrated child where the world and he collide not once, but frequently. He is a child living in a world filled with stimuli, all of which are interesting and equally important. He sees everything, but finds it difficult to focus on a single thing over time. When sitting in class, he knows he should listen to the teacher, but every noise and movement distracts him and makes it hard for him to hear. Sometimes he finds himself thinking about something else, only to realize he daydreamed while the teacher moved on. He constantly rushes to catch up with everyone, and something always pulls him off track. He works hard to sit quietly, but he constantly has a strong internal urge to move, stand up, or check other things. Contrary to what parents and teachers often think, this child exerts a lot of effort in class. He tries hard to listen, while for other children, this attentiveness comes naturally. His test scores are consistently lower than what he learned or knows, his notebook is empty because there wasn't time to finish writing down the lessons. Additionally, he doesn't always remember exactly what was said in class – he was busy with something else.
The problem also exists at home, especially in situations requiring concentration – there is a relative failure. Homework becomes an overwhelming burden for the child and his parents; he is often portrayed as lazy and spoiled, being told that "talking to him is like talking to a wall." He doesn't always perform the tasks assigned to him.
In many households, leaving for school in the morning becomes an impossible challenge, with severe arguments surrounding the slow and dreamy preparation of the child. Parents' frustration increases when they see that tasks that interest the child (and thus he manages to concentrate on) are done quickly.
Therefore, this child quickly becomes frustrated, angry, and offended. He experiences the world as incomprehensible and himself as unsuccessful and unintelligent. He lives in an atmosphere of constant negativity and frustration, both at school and beyond. Similarly, parents also become frustrated and angry, sometimes embarrassed by different behaviors, and the interaction between the child and them becomes increasingly difficult.
This child is also highly sensitive. Since he notices every stimulus, stimuli that other children don't feel, like noise or unintentional touches from another child, cause him distress or at least discomfort. Because of this discomfort, he reacts, and over time, this reaction becomes more and more aggressive. Such a child often creates a vicious circle where his reactions and anger make him the class's angry child, one who others enjoy challenging and irritating. At this point, these are no longer "unintentional" stimuli; they become intentional provocations, and he becomes the class's difficult and irritable child.
From a social perspective, this child often has many friends, but sometimes he gradually becomes isolated. Learning difficulties, excessive sensitivity, anger, and accumulating frustration increasingly make him a marginalized child, one who finds a solution to his difficulties through violence, a child who says, "If I can't be the best student in the class, I'll at least be the strongest and scariest one." He wants status, and if he can't achieve the status of the good and successful student, he will take on the role of the bully or the jester. This is a situation that's easy to fall into but difficult to escape, and it also leads to prolonged social deterioration.
Today, the course of the disorder is considered chronic. The estimate is that only 30% cease to suffer from the array of symptoms in adolescence, and even in those who recover, it is assumed that they continue to exhibit residual disorder, mainly scattered concentration. The main persistent symptoms are those of attention deficit, while hyperactivity gradually transforms over time into a feeling of internal restlessness.
In other words, even adults suffer from attention deficit disorder, though their expressions can be much broader than in children. On one hand, there is a group that functions quite well, and even exceptionally well. These are adults who utilize this trait to their advantage in the military, business, media, and other fields. On the other hand, there is a group with particularly low functioning, those who suffer from multiple comorbidities and who have reached a state of maladjustment. In the middle, there are many who function but struggle with the uncomfortable characteristics of the disorder and only partially benefit from its advantages.
Factors influencing the course include the presence of learning disabilities, which appear quite frequently – 30% in combination with attention deficit disorder, conduct disorder, depression, and anxiety. There is a danger, especially in the untreated group, of sliding towards delinquency and substance abuse. Due to the significance of comorbid illness, early diagnosis is the basis for these children's proper development.
What is the significance of diagnosing attention and concentration disorders?
ADHD is a neurological disorder primarily associated with learning difficulties, but its impact, especially when not diagnosed and treated, can be much broader and significant. According to estimates, about 80% of children living with attention and concentration disorders also face other challenges such as learning disabilities, anxiety, depression, behavioral disorders, a tendency towards addiction, tics, and more. In order to reduce the risk of these associated problems and minimize the impact of attention and concentration disorders on the child's life, it is important to identify the symptoms in a timely manner. The good news is that today, there is a good understanding of how to provide effective treatment for those living with attention and concentration disorders, which can reduce their impact on daily life.
Diagnosis is primarily a clinical diagnosis, and there is great importance in differentiating the disorder from other conditions that cause impairment in concentration and attention, some of which are normal and some pathological. These include various cognitive and emotional disorders, such as learning disabilities, anxiety, depression, bipolar disorder, substance use, psychosis, thyroid dysfunction, sleep disorders, and various physical impairments affecting vision or hearing. Additionally, issues with attention and concentration can develop as a result of renal or hepatic dysfunction.
As ADHD is a neurological disorder, the diagnosis must be carried out by a neurologist, a physician specializing in the nervous system, or a child psychiatrist. It should be noted that experienced family doctors and psychologists in this field can also diagnose attention and concentration issues, but they should refer to further testing by specialized physicians as needed.
Currently, there is no single test that definitively confirms or rules out the diagnosis. The diagnostician can use tools such as interviews with the child and parents, observations of the child and parents, behavioral scales, physical and neurological examinations, and cognitive tests. Laboratory tests, such as vision and hearing tests, can be effective in some cases. In certain situations, a speech and language evaluation may also be advisable. Developmental questionnaires designed for parents and teachers can be provided in the initial assessment.
Questionnaires like the Conners' Rating Scales are helpful for describing the clinical picture from the perspectives of both teachers and parents. A child with ADHD should exhibit symptoms both at school and at home, so both the teacher and the parent should complete the questionnaire. In typical cases, there is an integrated impairment in school functioning, social functioning, and family life. This questionnaire can also be used to assess the effectiveness of pharmacological treatment. Computerized diagnostic tools are available as additional aids in diagnosing attention and impulsivity issues, inattention, inconsistency, and slowness. These diagnostic tools are supplementary and do not replace the previously mentioned diagnostic methods.
The Continuous Performance Test (CPT) is a long-standing functional assessment tool that provides an objective evaluation of the attention component. This test directly assesses the child and their ability to cope with a relatively monotonous task over time. An example of a CPT used in Israel is the Test of Variables of Attention (T.O.V.A). This computerized test analyzes the response to stimuli – omissions, commission errors, and more. The child watches a computer screen for a fixed period of time and is expected to respond to one type of stimulus while ignoring another. The test measures the speed and accuracy of information processing by the child, comparing the results to norms for children of that age. T.O.V.A.'s sensitivity is 80%, and its specificity is 85%. The T.O.V.A. test also allows for assessing the efficacy of pharmacological treatment with an accuracy level of 95%.
Diagnosis according to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association):
The diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) is made when one of the following conditions is met:
- Six or more symptoms of inattention from the following list have been present for at least 6 months, to a degree that is inconsistent with developmental level and that negatively impacts social, academic, or occupational functioning:
- The child often fails to give a close attention to details or makes careless mistakes in schoolwork, work, or other activities.
- The child often has difficulty sustaining attention in tasks or play activities.
- The child often does not seem to listen when spoken to directly.
- The child often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
- The child often has difficulty organizing tasks and activities.
- The child often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).
- The child often loses things necessary for tasks and activities (e.g., toys, assignments, pencils, books, or tools).
- The child is often easily distracted by extraneous stimuli.
- The child is often forgetful in daily activities.
- Six or more symptoms of hyperactivity-impulsivity from the following list have been present for at least 6 months, to a degree that is inconsistent with developmental level and that negatively impacts social, academic, or occupational functioning:
- The child often fidgets with or taps hands or feet or squirms in the seat.
- The child often leaves the seat in situations when remaining seated is expected.
- The child often runs about or climbs in situations where it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness).
- The child is often unable to play or engage in leisure activities quietly.
- The child is often "on the go" or often acts as if "driven by a motor."
- The child often talks excessively.
- The child often blurts out answers before questions have been completed.
- The child often has difficulty waiting one's turn.
- The child often interrupts or intrudes on others (e.g., butts into conversations or games).
- Several symptoms of inattention or hyperactivity-impulsivity were present before age 12.
- Several symptoms of inattention or hyperactivity-impulsivity are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).
- There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.
- The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder, and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or personality disorder).
Children diagnosed with ADHD can be classified into one of three subgroups:
a. Inattentive type: primary attention deficit disorder.
b. Hyperactive-Impulsive type: primary hyperactivity.
c. Combined type: both attention deficit disorder and hyperactivity.
It should be noted that there is an additional group of children who primarily exhibit attention and concentration difficulties without excessive hyperactivity. These children are characterized as quiet, passive, and dreamy.
The symptoms associated with attention and concentration disorders are very common, and not all of them necessarily indicate the presence of a neurological disorder. Even if the assessment concludes that the individual does not suffer from attention and concentration disorder, there may still be other underlying difficulties that are hidden beneath the surface and can pose challenges for them.
In order to identify and properly address these challenges, it is advisable to consider seeking the assistance of a child psychologist or an educational psychologist. It is also possible to consider a psychoeducational assessment to identify learning disabilities such as dyslexia, speech impairment, or reading difficulties.
What does treatment for children with attention and concentration disorders include?
This disorder is a complex condition with both positive and negative aspects, expressed mainly in certain situations. Therefore, treatment does not involve chronic intervention or achieving a "change in the child" or "correction of the child." On the contrary, the goal of treatment is to accompany the child or adolescent, enable their optimal development, minimize side effects and harm as much as possible, and help them recognize their strengths and uniqueness as assets rather than deficits. In other words, treatment, especially pharmaceutical treatment, is rather temporary and adapted to the individual's condition, and not a permanent fixture.
The first thing that comes to mind when discussing treatment for attention and concentration disorders is stimulant medications that are closely associated with ADHD. However, it is now understood that effective treatment addresses the issue holistically and considers various aspects of coping with the disorder. Such treatment typically occurs across three dimensions:
- Pharmacological treatment – The medications given to children with attention disorders affect the central nervous system in a way that enhances concentration and promotes calmness, attentiveness, and focus. The use of these medications, like any other medication, may involve side effects, although in most cases, these side effects are very mild. It's important to emphasize that none of the medications prescribed to children lead to addiction or cause harm to the kidneys or liver.
- Emotional support – Various therapeutic methods can help children understand the challenges they face, develop coping strategies that suit them, and discover how to turn their difficulties into strengths. Research has shown that Cognitive-Behavioral Therapy (CBT) may be beneficial in this regard, as well as personal coaching, art therapy, physical activities, drama therapy, and more. Each of these approaches is suitable for different children, and it's important to find the one that the child connects with and benefits from the most.
- Environmental and lifestyle adjustments – Many factors affect our ability to function effectively over time. Experts now recommend implementing various adjustments in daily routines to alleviate the child's difficulties, improve their condition, and reduce the symptoms that hinder them. Such changes may include adopting a healthier diet, engaging in physical activities, reducing stress through methods like meditation or yoga, and maintaining order and organization.
The society in which the child is situated must be aware of their challenges, anticipate potential trouble spots, be flexible in response to changes, and possess understanding and knowledge of how to cope. For this purpose, it is crucial to collaborate with the school and provide the child with a place in treatment and room for change.
Therapeutic Treatment for Attention Deficit Hyperactivity Disorder (ADHD)
The treatment for attention deficit hyperactivity disorder (ADHD) is primarily based on the use of psychostimulants, which are short-acting drugs that stimulate the central nervous system. The first choice for treatment, which is widely recognized and effective, is usually methylphenidate, commonly known as Ritalin. Ritalin is a derivative of amphetamine and allows for focused attention for about four hours. It is highly effective, with 85% of children responding positively to it, often resulting in significant functional improvement. The dosage can be adjusted according to the specific needs of the individual, such as during school hours, exams, and other activities.
Ritalin does have some side effects, which can be categorized as follows:
- Common and transient side effects: Many children report headaches or stomach aches in the first days of taking the medication. These side effects usually resolve within a week or two.
- Persistent side effects: Ritalin, being an amphetamine derivative, can suppress appetite and interfere with sleep during its active hours. It should not be taken in the evening, and the reduced appetite should be considered throughout the day (if using long-acting Ritalin).
- Non-responsive cases and even exacerbation of symptoms: In some cases (15%), individuals may not respond to Ritalin or may experience concentration impairment instead of improvement. This should be assessed with cognitive tests before starting treatment.
- Severe side effects: Rare side effects include a "rebound" effect after the medication wears off, causing increased restlessness. Long-acting Ritalin can help reduce this effect.
For many patients, concerns about taking medication that might "change" or suppress them are normal. These feelings often diminish over time. Common side effects can be managed, such as taking the medication with food to reduce appetite suppression or adjusting the timing to minimize sleep disturbances.
ADHD is a chronic condition that persists into adulthood and is often associated with impulsivity, outbursts, violence, and academic challenges. Treatment with medication, particularly long-acting Ritalin, can significantly assist adults in various aspects of their lives.
There are alternative non-stimulant medications available for cases where stimulant medications are not effective or have intolerable side effects. These alternatives, such as Atomoxetine, Guanfacine, Clonidine, and Bupropion, may be more suitable for individuals who experience side effects from regular medications. It's important to mention that all medications, even those not life-threatening, can have side effects.
In conclusion, the treatment for ADHD is tailored to each individual's needs and can significantly improve their quality of life. Medications like Ritalin have been widely used and studied, showing efficacy and safety in managing ADHD symptoms. It's important for individuals and their families to discuss any concerns or questions with their healthcare providers before starting any treatment.
Treatment for attention and concentration disorders without medication.
Treatment for attention and concentration problems without Ritalin: When and for whom is it recommended?
When discussing attention and concentration disorders, they cannot be regarded as a single challenge that affects everyone in the same way. Every child (or adult) living with such a disorder is affected differently, copes with unique challenges, and also responds differently to various types of treatments.
The decision whether to use medication or other approaches to address the problem should be made on an individual basis and after a thorough assessment of your child's specific needs. It's also important to understand that there's no black or white answer – it's possible and desirable to ask questions at different points along the way if the chosen approach is correct – and how it can be improved.
Furthermore, it's advisable not to hesitate alone. Around you, there are teachers, professional advisors, and specialized doctors who are well acquainted with dealing with ADHD and will help you make a decision that truly benefits your child. Generally, the ideal treatment will involve a combination of different approaches – medication, emotional therapy, and various adjustments in the environment and daily routine. If you've decided not to use medication, such as Ritalin, there are many other things you can do to ensure a smoother, healthier, and more balanced path for your child's learning and future.
ADHD is a neurological disorder, and therefore, medications that affect the central nervous system are considered effective in its treatment. However, emotional therapy has also been proven in studies to provide benefits in addressing the issue and improving the child's coping. The most common approach in this context is Cognitive Behavioral Therapy (CBT). Art therapy, guided imagery, and meditation can also be effective in this context.
Those living with attention and concentration disorders don't just struggle with learning difficulties. These children often feel (unjustly) that they are less talented or intelligent than their peers. This can lead to self-esteem issues, lack of confidence, and social difficulties. When the problem is not diagnosed, they may also be perceived as "lazy" or "problematic," which, of course, has a prolonged impact on their mental health.
CBT therapies are highly beneficial in this regard since they are short-term, goal-oriented, and suitable for children and adolescents. In such therapy, less focus is given to the past and more emphasis is placed on the present and future. Numerous studies on this approach have found it to be effective in treating those living with ADHD.
Additionally, a series of recent studies have shown how physical activity contributes to improving attention and concentration – not only in children and adults with ADHD but in everyone. Physical activity also contributes to longevity, reduces the risk of diseases, strengthens the immune system, and positively affects mental resilience and stability. Nutrition, of course, also impacts all of these factors and neurological processes related to attention and concentration disorders.
The most powerful impact, it's important to emphasize, is achieved through the combination of emotional and medication therapy – but even emotional therapy alone, without medication for attention and concentration disorders, can definitely contribute significantly in this context.
Parents also have a crucial role in improving coping with ADHD. Children and adolescents living with attention and concentration disorders will likely face many challenges and difficulties along the way. Therefore, it's so important that parents, siblings, and the immediate environment are aware of these challenges, exhibit greater sensitivity towards them, and know how to help. Parental guidance can certainly help to manage interactions with the child and adapt the environment to their needs.
Remember that children like these need a lot of attention, positive reinforcement, and praise. Instead of getting angry, criticizing, or giving punishments – try to discover together with them what they are good at, what their strengths are, and what special talents they have – and give those aspects meaningful attention. At the same time, set boundaries and rules, and let them feel that you are always there to help, guide, and support them in everything they need. Treatment for attention and concentration disorders must be carried out on multiple levels. One of the central factors is the involvement of the environment, especially the immediate family, in the child's life. Children who receive a lot of warmth and love, compliments, and praise – but also constructive criticism and guidance – will inevitably cope better with their challenges. This is true not only for those with ADHD but for every child and adolescent.
It's very important to ensure that the environment is supportive and not harmful to the child. In this context, it's important to maintain order and organization, ensure that the child sleeps as needed, reduce stressors in their life, and especially not overload them with demands and expectations they cannot meet. Instead, focus on highlighting their talents and areas where they excel. For example, many children with attention disorders excel in music, art, sports, or other areas. Help the child discover their unique talent and empower them to build their confidence and sense of capability.
The relationship with the child's teachers and support teams is also a crucial factor in this journey. Ensure that teachers are involved in your efforts, understand the challenges the child is facing, and know how to assist them in the best possible way. Ask them about their performance in studies and request that they inform you about any unusual behavior or significant changes. Moreover, this might sound like an obvious recommendation, but it's not always so – talk with the child much more, ask them much more, and encourage them to understand that they can share everything with you – even the less pleasant things that sometimes they don't want to talk about.
Every child has the right to express their intellectual and emotional abilities. Therefore, ancillary treatments alongside medication can greatly assist in comprehensive treatment for the child.
Despite its significant effectiveness, medication-based treatment must also be accompanied by supportive interventions both at school and at home.
Even with medication-based treatment, children with ADHD sometimes exhibit higher levels of behavioral problems compared to their peers, despite improvement in impulsivity, attention deficits, and hyperactivity.
Following medication treatment, the improvement in academic achievements and social functioning is often not sufficient. Therefore, when choosing a treatment for a child, it is important to consider the options for ancillary treatments provided by a professional team. Ideally, these treatments should be integrated in conjunction with the primary treatment.
Goals of ancillary treatment: Detection and treatment of accompanying behavioral disorders, promotion of academic and social learning, enhancement of social adaptation and social appreciation, and family therapy. There is a wide range of options for ancillary treatments, each with its advantages and disadvantages.
Accepted ancillary treatments include classroom interventions, behavioral therapy, psychological and educational interventions for the child, and parental guidance.
Most children spend the majority of their childhood within the education system. Few children with attention and concentration difficulties study in special schools or special classes. Most children study in regular classes in regular schools, which presents a significant challenge in integrating these children into regular classrooms. Many children with attention problems suffer from low self-esteem. Therefore, it is crucial to provide these children with a positive experience.
The teacher plays a central role in improving the child's self-image and performance at school.
- It is recommended for the teacher to seat the child close to the teacher's desk.
- Mediation by the teacher is recommended. This means keeping an eye on the student and ensuring they pay attention during class, and encouraging questions from the child during the lesson.
- Children with excessive movement are recommended to take short breaks outside the classroom from time to time during the lesson, if possible.
- Attaching a mentor from a higher grade to a child with learning difficulties is highly recommended.
- Positive reinforcement for the child's achievements is highly recommended.
- Daily communication between the teacher and parents is recommended, either through a communication notebook or email.
- The teacher, school psychologist, and school counselor should initiate conversations with the parents about the child's condition and ways to improve their functioning. These discussions should be empathetic, understanding the child's difficulties, rather than accusatory or complaining.
The educational staff should inform parents about the available treatment options within the education system, such as occupational therapy, communication clinics, psychological therapy tailored to children's age, and instructional therapy. It is not appropriate to recommend such treatments in very expensive diagnoses that parents cannot afford, especially when dealing with young children, whose cognitive abilities are not at question.
The educational staff also has an important role in identifying children who may suffer from attention and concentration difficulties and assisting them in integrating into the school system if such difficulties exist.
Adult Attention and Concentration Disorders
Adults with ADHD: What Does It Mean and How Does It Affect Life?
According to estimates, about two-thirds of children living with attention and concentration disorders will continue to suffer from them in adulthood. In the absence of appropriate treatment and proper guidance, this can significantly impact their journey – not only in work and studies but also in managing relationships and a wide range of emotional and psychological aspects.
In many cases, parents who bring their children for diagnosis of these disorders discover that they themselves exhibit the symptoms. This is because attention and concentration disorders also have genetic origins and are more likely to be diagnosed in children whose parents have ADHD.
Data shows that attention and concentration disorders are relatively common among individuals over the age of 18 and are diagnosed in about 4 to 7 percent of the adult population. In the past, it was believed that this issue mainly affected children who needed to sit for long hours in school, take tests, and pay attention during lessons. Today, it is understood that the impact of ADHD is much broader and becomes more complex as the world advances.
In fact, the modern world is not particularly accommodating to adults with attention and concentration disorders – quite the opposite. The amount of stimuli around us continues to increase over time, the work environment favors those who can sit for long hours in front of a computer, and many traits considered crucial for success, such as persistence, ignoring distractions, and willingness to invest effort in "boring" tasks, are difficult to develop for individuals with ADHD.
What Are the Differences Between Attention and Concentration Disorders in Adults and Children?
In general, attention and concentration disorders manifest in a long list of symptoms – some of which are very common and others less so. Each individual who is diagnosed with the disorder will experience slightly different symptoms in terms of intensity, frequency, and impact. The main difference between children and adults in this context is that adults have likely developed compensatory mechanisms over time. They have also probably chosen to focus on work and hobbies that better align with their unique abilities.
On the other hand, an undiagnosed disorder from childhood can lead to a sense of inadequacy, low self-confidence, and self-esteem. Such difficulties, according to research, can sometimes increase the likelihood of addictions, social isolation, and risky behaviors.
The challenges that need to be faced also change as one grows older. While children with attention and concentration disorders may struggle to sit in class all day or complete homework assignments in the evening, adults may have difficulty paying bills, managing taxes, experiencing restlessness, and frustration when required to work in an office, and at times feel unable to maintain stable and healthy relationships.
Coping with ADHD in adulthood can be even more complex, partly because adults tend to engage in less physical activity, running, and playing compared to children. Therefore, they may not expend enough energy throughout the day, leading to higher levels of restlessness, stress, and anxiety.
What Are the Symptoms of Attention and Concentration Disorders in Adults?
As mentioned, the symptoms of attention and concentration disorders in adults are very similar to those in children, although their expression may be slightly different. The most common symptoms include difficulty sustaining attention or listening over time, memory problems, procrastination, avoidance of "boring" tasks, frequent misplacement of items, sleep difficulties, fidgeting or "tapping" hands and feet, constant talking, interrupting others' speech, impulsivity in conversations, and difficulty waiting patiently.
These are just some of the symptoms of attention and concentration disorders, and even if you recognize them in yourself – it does not necessarily mean you have the condition. A positive diagnosis will be made following a thorough examination of the quantity of symptoms, their scope, frequency, and their impact on your life.
How does the diagnosis of attention and concentration problems appear in adults?
The diagnosis of attention and concentration disorders is generally considered simpler and faster in adults compared to the parallel process in children. While in children, the process often involves in-depth psychoeducational assessment to identify learning disabilities and other difficulties that may impact the condition, adults can often be assessed with a more streamlined evaluation. However, it's important to have this assessment conducted by a qualified and experienced professional who specializes in the diagnosis and treatment of ADHD.
Such a diagnosis can only be performed by psychologists who specialize in treating attention and concentration disorders, specialized neurologists, psychiatrists, and family doctors with expertise and experience in this field. If the result is positive, it's important to note that only a medical doctor can prescribe medication to improve the condition.
It should be emphasized that currently, there is no definitive test for diagnosing the condition, and the determination is based on clinical estimation. This includes comprehensive patient interviews, clinical assessments, various cognitive tests, and accurate mapping of symptoms according to the DSM-5 definition – the diagnostic and statistical manual of mental disorders published by the American Psychiatric Association.
It's possible that the process may also involve additional medical tests to identify underlying problems that might contribute to the appearance of ADHD symptoms.
What does treatment for attention and concentration disorders in adults include?
Pharmacological treatment is considered the most effective for alleviating specific symptoms of attention and concentration disorders, and it is completely safe for use in both children and adults. Many individuals use medication to enhance their functioning, especially those who need to sit in front of a computer all day at work.
However, alongside medication, there is a wide range of tools that can positively impact life alongside ADHD. Emotional therapy can make a significant difference in coping, overcoming challenges, and enhancing personal capabilities. Such therapy can also help identify related problems and effects that may have developed as a result of dealing with the disorder.
Moreover, positive lifestyle changes such as physical activity, healthier nutrition, meditation practice, and establishing order and organization can greatly improve your ability to manage the challenges posed by the disorder and reduce its negative impact.
Guidance from a professional, such as a psychologist familiar with the unique challenges faced by individuals with attention and concentration disorders, can certainly help you not only overcome difficulties but also turn your weaknesses into strengths, empower your unique talents, and see the advantages in your unique qualities.
What is the impact of diet and nutritional supplements on attention and concentration disorders?
Our bodies require balanced nutrition to keep us healthy and happy. Therefore, it's important to adhere to proper eating habits according to a balanced diet. This is especially crucial for children, who need food to grow and develop properly. Balanced nutrition takes on special importance for children with ADHD.
Research has found that among children with ADHD, those who consume healthy food according to a balanced and nutritious menu tend to exhibit better behavior and greater success at school. This may also positively affect their behavior within the family context.
A balanced and nutritious menu is based on vegetables, fruits, whole grains, low-fat dairy products, eggs, lean meats, fish, lean meat, nuts, and beans. It's important that consumption of trans fats, cholesterol, and saturated fat is low. Additionally, reducing salt and white sugar is recommended.
A varied menu that includes various food groups, including carbohydrates, proteins, and fats, in appropriate amounts for the child's height and desired weight, will provide a more balanced nutrition for the child and can contribute to better management of ADHD symptoms.
Omega-3 and omega-6 fatty acids, often referred to as "good fats," play a critical role in our neurological function and are also important in reducing the severity of attention and concentration disorders. These fatty acids are found in saltwater fish, nuts, seeds, avocado, and eggs.
Furthermore, it's highly recommended to include whole grains, lentils, beans, leafy greens, fruits, and a variety of colorful vegetables in the menu. At the same time, it's advisable to reduce the consumption of fried foods, caffeine, white sugar, trans fat, artificial flavors, colors, and preservatives – basically, all the things children often love.
Some individuals with ADHD have found benefits from adopting the Feingold Diet, which involves removing artificial additives, flavorings, and certain sweeteners from the diet.
Another approach that can be beneficial for some patients is limiting sugar and certain artificial sweeteners, such as aspartame, from the diet.
Apart from these, it's important to ensure that the child's diet is balanced and provides adequate amounts of vitamins and minerals that are important for growth and proper brain function. These are crucial for the functionality of the brain. Considering a multivitamin supplement might be beneficial if the child's diet is not adequately balanced.
Eating according to a structured schedule can prevent mealtime frustration and prevent fluctuations in blood sugar levels, which can lead to increased irritability and reduced concentration, particularly in children with ADHD.
Please note that these dietary and nutritional recommendations are general guidelines and may not apply to all individuals with attention and concentration disorders. Consulting a qualified healthcare professional, such as a registered dietitian or a medical doctor, is advisable before making significant dietary changes or introducing supplements.
List of foods suspected of increasing the risk of attention and concentration disorders, along with their alternative replacements:
- Sugar and Sweets
More than being harmful by itself, a diet rich in sugar replaces proper nutrition and deprives the body of essential nutrients. Instead of consuming vegetables, children indulge in snacks and junk food, which can potentially lead to concentration difficulties. Consumption of sugary foods with a high glycemic index causes rapid spikes and drops in blood sugar levels, leading to hyperactivity followed by rapid blood sugar decrease, potentially contributing to nervousness and fatigue. Although a clear link between sugar and exacerbating attention and concentration disorders (ADHD) hasn't been established, limiting sugar intake is important for maintaining a healthy body weight. The sharp increase and rapid decrease in blood sugar levels from consuming these foods might contribute to concentration and focus difficulties in children with attention and concentration disorders.
So, what's the alternative?
Fruits, while also containing sugar, provide vitamins, minerals, and dietary fiber, allowing fruit fructose to break down more slowly and be metabolized more effectively. Fruits with relatively low glycemic index values, like apples, pears, peaches, apricots, and berries, are recommended. Watermelon and grapes, unfortunately, are not recommended, at least not in large quantities.
- Dairy and Dairy Products
In Chinese medicine, dairy is considered warming and is believed to cause instability and restlessness. Some claim there is a close connection between lactose sensitivity and attention disorders. While science has not firmly established this link, natural medicine suggests that consuming less dairy might promote calmness and concentration.
So, what's the alternative?
Quality dairy substitutes like soy, almonds, and rice are readily available. These options are usually well-liked by children, and despite their relatively higher cost, they are recommended. You can also find dairy alternatives like tofu and soy cheese, which are both healthy and tasty.
- Allergenic Nuts
Immediate suspects include walnuts and peanuts, along with other salted and roasted nuts that release unnecessary and harmful salt particles.
So, what's the alternative?
Non-allergenic nuts like almonds, sesame seeds, pumpkin seeds, and sunflower seeds can be consumed instead.
- Red Meat and Eggs
These foods are excellent sources of protein but can also be allergenic. Alongside dairy and peanuts, eggs are prominent on the list of allergenic foods, which is critical for individuals with attention and concentration disorders. Red meat also has allergenic properties.
So, what's the alternative?
Fish is a great source of animal protein, while legumes in all their variations (e.g., lentils, chickpeas, different types of beans) and sesame seeds can provide plant-based protein sources. These options can be a welcome addition to the diet.
- Wheat, White Flour, and their by-products
Similar to lactose sensitivity, gluten sensitivity, which is associated with wheat protein, has been linked to attention disorders. Wheat is highly allergenic, and given the variety of alternatives available in the market for bread and pastries made without wheat flour, eliminating wheat from the menu shouldn't be a problem.
So, what's the alternative?
Whole grains offer a plethora of choices, including oats, spelt, barley, quinoa, amaranth, buckwheat, millet, and more.
- To exclude! Partially hydrogenated vegetable fat (and fully hydrogenated), trans fat, preservatives, food colorings.
What hasn't been said yet about partially hydrogenated fat and trans fat? Products containing them should stay off your plate, regardless of any attention disorder. During the production process of these fats, toxins are formed that find their way onto your plate and into your body.
So, what's the alternative?
Leafy greens (various types of lettuce, herb leaves, cabbage), cruciferous vegetables (cauliflower, broccoli, Brussels sprouts, cabbage, kohlrabi, and turnips).
Individuals with attention disorders tend to consume less healthy food. They are aware of the risk but find it challenging to resist when faced with it. To minimize this impulsive pattern, it's important to highlight healthy food and increase its attractiveness and accessibility in the living environment.
Recommended Nutritional Supplements:
Essential Fatty Acids - Recently, the connection between essential fatty acid deficiency and attention disorders has been studied. Certain research found lower levels of essential fatty acids, especially omega-3 (DHA and EPA), in boys with attention disorders compared to a control group. Although conclusive evidence that adding long-chain fatty acids to the diet improves ADHD symptoms is lacking, there is evidence that a deficiency in essential fatty acids could be a contributing factor to ADHD.
Magnesium, Iron, Zinc - It's important to check for deficiencies in these minerals and consume nutritional supplements containing them as needed. These minerals play a significant role in cognitive processes. Studies show that providing supplements containing these minerals to children with ADHD who were deficient in them reduced the severity of their symptoms.
L-Carnitine - Studies have shown that providing a supplement of the amino acid L-carnitine to the diet of children with ADHD reduced their symptoms. L-carnitine has an important role in brain function.
Saffron - In recent years, several clinical studies have shown that a patented saffron extract called AFFRON® is effective in improving learning ability, concentration, focus, mood, reducing tension, anxiety, and more.
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