Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. It is typically diagnosed in childhood and often persists into adulthood. The exact causes are unknown but are believed to involve genetic and environmental factors that affect brain development and neurotransmitter function. Common comorbid conditions include learning disabilities, depression, and anxiety. Treatment involves behavioral therapy, classroom accommodations, and medication such as stimulants. Ongoing research aims to better understand the neurological mechanisms, identify genetic and environmental risk factors, and develop new therapeutic approaches.

1. ADD/ ADHD
DEFINITION:
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) IS A GROUP OF
BEHAVIOURAL SYMPTOMS THAT INCLUDE INATTENTIVENESS, HYPERACTIVITY
AND IMPULSIVENESS.
• ADHD CAN OCCUR IN PEOPLE OF ANY INTELLECTUAL ABILITY,
ALTHOUGH IT IS MORE COMMON IN PEOPLE WITH LEARNING
DIFFICULTIES.
• SYMPTOMS OF ADHD TEND TO BE FIRST NOTICED AT AN EARLY AGE,
AND MAY BECOME MORE NOTICEABLE WHEN A CHILD'S
CIRCUMSTANCES CHANGE, SUCH AS WHEN THEY START SCHOOL.
MOST CASES ARE DIAGNOSED IN CHILDREN BETWEEN THE AGES OF 6
AND 12.
• THE SYMPTOMS OF ADHD USUALLY IMPROVE WITH AGE, BUT MANY
ADULTS WHO ARE DIAGNOSED WITH THE CONDITION AT A YOUNG AGE
WILL CONTINUE TO EXPERIENCE PROBLEMS.
(NHS, 2014)

2. Symptoms
Inattentiveness (ADD) Hyperactivity / Impulsiveness (HD)
Short attention span, easily
distracted
Unable to sit still especially in calm
quiet environment
Making careless mistakes Constantly fidgeting
Appearing forgetful / losing things Being unable to concentrate on
tasks
Unable to stick to task that is time
consuming or tedious
Excessive physical movement
Unable to listen or carry out
instructions
Excessive talking
Constantly changing activity or
task
Unable to wait their turn
Having difficulty organizing tasks Acting without thinking
Interrupting conversations
No sense of danger

3. Explanatory Model
Barkley (1997, 1998, 2000)
 notes that persons with ADHD have difficulties with executive functions.
 Executive functions involve a number of self-directed behaviors, such as
working memory, inner speech, and self-regulation of emotions.
 Working memory is the ability to hold things in mind while also engaging in
other cognitive tasks.
 Problems in working memory can affect the ability of the person with ADHD
to have hindsight and foresight
 Inner speech is the inner "voice" we use to "talk" to ourselves when faced
with difficult problems. This speech may start out as talking out loud and then
become internalized over time.
 Self-regulation of emotions also presents problems for many students with
ADHD. They often overreact to emotionally charged situations.
 Barkley hypothesizes that such problems in regulating emotions contribute to
motivational problems for individuals with ADHD. They are unable to channel
their emotions to help them persist in the pursuit of future goals. And having
learning disabilities in combination with ADHD makes it even more difficult to
maintain motivation in the face of failure.
 Response inhibition is essential for all behavioural function

4. Neuroscience view
 studies and the cognitive neuroscience literature, those using
functional imaging have tended to focus on brain region that are
normally involved in attention/cognition, executive function, working
memory, motor control, response inhibition, and/or reward/motivation
 implicated fronto–striatal abnormalities (particularly dysfunction of
dACC (dorsal Anterior Cingulate Cortex) lateral prefrontal cortex, and
striatum) as possibly playing roles in the production of ADHD
symptomatology.
(Bush et al, 2005)
 dACC, also referred to as the “cognitive division,” has been shown to
play important roles in attention, cognition, motor control, and
reward-based decision making;
 Counting Stroops test (considered to measure selective attention,
cognitive flexibility and processing speed, and it is used as a tool in the
evaluation of executive functions) has shown Hyperactivity in dACC
for children and adults Go-NoGo test (used to measure a participant's
capacity for sustained attention and response control) has shown
hypoactivation in dACC
(Tamm et al, 2004, Bush et al, 2000)

5.  fails to follow Mendelian patterns of inheritance and is classified as
a complex genetic disorder
(Cardinal et al, 2001)
Critical points to consider:
 Brain imaging results are much too inconsistent to be interpreted
meaningfully and may be confounded by prior medication
exposure
 Less attention has been paid to orbitofrontal cortex, even though
lesions of this region are associated with social disinhibition and
impulse control disorders
 some of the most important tasks facing researchers in the future
will involve actively searching for similarities and differences
among different age groups and placing findings within a
developmental perspective
(Bush et al, 2005)

6. Environmental/ Parental
 hyperactivity/inattention were found to be predicted by the interaction between
inconsistent discipline and child age. In previous cross sectional research,
inconsistent discipline has been uniquely associated with ADHD symptom severity
 relatively little research has examined the unique associations between specific
parenting variables and hyperactivity/inattention across development
(Ellis & Nigg, 2009)
 It has also been implicated in a gene x environment interaction, with finding a
specific dopaminergic gene to be associated with increased risk for ADHD only in
the presence of highly inconsistent discipline (Martel et al.2011, Hawes et al, 2013)
 Parental involvement: high level parental involvement has been associated with
low level of ADHD, however only among children of lower age range
 disruptions to environmental contingencies—as seen in inconsistent discipline –
appear to operate most adversely on these capacities later, in middle childhood.
(Hawes et al, 2013)
 Poor parental skills strongly contributes to children’s self control deficits and to the
development of other disruptive behaviours associated with ADHD
 Behavioural parent training for families of children with ADHD may improve
parental functioning and reduce children’s oppositional and aggressive behaviour;
however, poor attendance and parental psychopathology may limit the usefulness
of parent training.
(Modesto – Lowe et al, 2008)

7. Critical points to consider:
 There are three main ways that psychiatric geneticists and behaviour
geneticists have made the case for the genetic basis of ADHD: family,
twin, and adoption studies
 Although family studies might be able to demonstrate the familiality of
ADHD, due to the fact that families share a common environment as
well as common genes does not permit any conclusion about a
genetic component for the diagnosis.
(Joseph, 2000)
 Effect of ADHD on parental functioning: These parents typically display
high levels of over- reactivity and tend to be more critical of their
children, less rewarding, and less responsive than parents of children
without ADHD.
 Moreover, the degree of parental dysfunction appears to correlate
with the presence and severity of ADHD-related disruptive disorders
such as ODD and CD.
 Social learning theory (Bandura, 1977) is important to consider as root
of many psychiatric disorders in children
(O’connor & Scott, 2007)

8. Comorbidity
 About 67 % of children with ADHD has one or more other
neurodevelopmental disorders or learning disability compared to
11 % of children with no ADHD. (33 % had one 18% two or three 16
% two comorbid condition)
 Learning disorders (46% vs 5%)
 Conduct disorder (27% vs 2%)
 Anxiety (18% vs 2%)
 Depression (14% vs 1%)
 Speech problems 12% vs3%)
 Autism spectrum Disorder (6% vs0.6%)
 Epilepsy/Seizures (2.6% vs0.6%)
 Oppositional Defiant Disorder
 Sleep Disorder
 Bipolar Disorder
(Patel et al, 2012)

9.  Over 50 % children with ADHD have a learning disorder, however, it must be
treated separately, as treating the symptoms of ADHD will not eliminate LDs
 Dyslexia is very common in children with ADHD, while Dyscalculia is more
prevalent in children with ADD only
(Shaywitz, 1992)
 The causal pathways leading to co-morbidity between ADHD and dyslexia
are not well understood, but researchers agree that their coexistence is not
artifactual because associations have been observed in different
epidemiological samples and across diverse settings
 each is evaluated by different methods: ADHD by parent and teacher ratings
of behaviour and dyslexia by direct tests of reading performance.
 Two major theories on ADHD comorbidity with dyslexia:
1. phenocopy hypothesis This model proposes a bi-directional influence such
that behavioural problems associated with ADHD disrupt learning to read,
hence making the child appear dyslexic or, by the same logic, frustrations
due to reading problems making the dyslexic child appear inattentive
2. cognitive subtype hypothesis makes an association with etiological factors
and posits that co-morbid groups in fact represent a third disorder that is
due to either etiological factors that are distinct relative to those related to
each disorder alone
(Rucklidge & Tannock, 2002)

10. Classroom Intervention
 Task Duration (due to short attention span, assignments should be brief, and immediate feedback given on accuracy i.e.
long term project broken into smaller parts)
 Task difficulty (matching tasks to student’s skill level, as students with ADHD tend to give up and become frustrated quicker if
task is too hard, or bored and inattentive if it is to easy)
 Direct Instruction ( Behaviour can be improved if child is engaged in teacher led activity rather than independent seat work,
direct explicit instruction improves on-task behaviours)
 Peer tutoring ( shown to be effective in academic and behavioural gains, peer tutor has to have higher academic
achievement and better behaviour and the same gender and age as the student with ADHD)
 Scheduling (on task behaviour of ADHD students worsen during the day, therefore critical instruction has to be given in the
morning, and more active non-academic activities should be scheduled in the afternoon)
 Novelty (reduces activity, increases attention, for example; teacher could use brightly coloured papers, animations, even
different intonations when giving instructions or teaching a lesion students with ADHD respond positively to novelty)
 Productive Physical environment (it is useful to include active breaks for these children, such as stretch breaks, or to give
them any physical activity, watering plants, taking note to another teacher, feeding animals)
 Passive/ Active Involvement (could help hyperactive students t channel their disruptive behaviour if they are actively
involved in the classroom i.e. writing important points on the board, assist the teacher)
 Powerful external reinforcement (these reinforcements are beneficial for any student, however it is better to provide these
quicker and more frequently to ADHD children)
 Choice (having more choices of activates or assignments for ADHD student can increase on- task behaviour)
 Clear, Direct instructions ( instruction have to be short, clear, using more direct words, teachers have to be prepared to
repeat directions frequently, may even ask student to rephrase directions in her/ his own way to ensure understanding)
 Structure and organization (ADHD students respond positively to having daily routine and predictability, they should be
notified well before changes happen to any routine)
(Brock et al, 2006)

11. Medical Intervention
 Since most ADHD children have comorbid disorders, combination
of different treatment modalities is usually indicated
 In both European and US guidelines, stimulants (including
methylphenidate and dexamphetamine) are mentioned as the
first-choice drugs in the pharmacological treatment of ADHD
 stimulants also improved associated behaviour, including on-task
behaviour, academic performance and social functioning on a
short term
 pharmacotherapy of ADHD in children is proven to be effective.
(Mejier et al, 2009)

12.  Methylphenidate (Ritalin): Methylphenidate is the most commonly
used medication for ADHD. It belongs to a group of medicines
called stimulants that work by increasing activity in the brain,
particularly in areas that play a part in controlling attention and
behaviour. (can be used over age of 6)
 Dexamfetamine (Dextedrine, Focalin): works same way as above,
can be used over age of 3
 Lisdexamfetamine (Vyvanse): works same way, can be used over
age of 6
 Atomoxetine (Strattera): It is known as a selective noradrenaline
uptake inhibitor (SNRI), which means it increases the amount of a
chemical in the brain called noradrenaline. This chemical passes
messages between brain cells, and increasing the amount can aid
concentration and help control impulses. Can be used over age of
6
(NHS, 2015)
 Adverse effects: loss of apetite – reduction in expected growth,
Sleep disorder, possible cardiovascular effects – especially in case
of Atomoxetine
(Mejier et al, 2009)

13. Therapeutical Intervention
 CBT: the child can be helped to talk about upsetting thoughts and feelings, explore self-defeating
patterns of behaviour, learn alternative ways to handle emotions, feel better about him or herself
despite the disorder, identify and build on their strengths, answer unhealthy or irrational thoughts, cope
with daily problems, and control their attention and aggression. Such therapy can also help the family
to better handle the disruptive behaviours, promote change, develop techniques for coping with and
improving their child’s behaviour.
 Behaviour Therapy: is a specific type of psychotherapy that focuses more on ways to deal with
immediate issues. It tackles thinking and coping patterns directly, without trying to understand their
origins. The aim is behaviour change, such as organizing tasks or schoolwork in a better way, or dealing
with emotionally charged events when they occur. In behaviour therapy, the child may be asked to
monitor their actions and give themselves rewards for positive behaviour such as stopping to think
through the situation before reacting.
 Social Skills Therapy: Social skills training teaches the behaviours necessary to develop and maintain
good social relationships, such as waiting for a turn, sharing toys, asking for help, or certain ways of
responding to teasing. These skills are usually not taught in the classroom or by parents — they are
typically learned naturally by most children by watching and repeating other behaviours they see. But
some children — especially those with attention deficit disorder — have a harder time learning these
skills or using them appropriately.
 Support Groups for ADHD
(Martin, 2007)
 SDBT (Structured Dyadic Behaviour Therapy): it is a novel behavioural therapy for children aged 7 – 12.
combines self regulation techniques and social learning, highly structured and model driven, uses
intensive contingency management methods, based on operational and classic conditioning uses
modelling, interactive rehearsal, peer feedback intended to teach children social management of
their behaviour. It is a collaborative, children work in pairs, which includes: Establishing Collaborative
Behavioural Goals, Behavioural Benchmarking , Orienting Attention and Redirecting Using Effective
Commands. The main aim of the therapy is self- regulation.
( Curtis, 2014)