How does "Attention Deficit Disorder (ADHD)" occur, what are the main symptoms, and how should they be diagnosed and treated?

I am a diagnosed mixed adult adhd (hyperactivity disorder, attention deficit hyperactivity impulse disorder). I am currently a graduate student in psychology. After I was diagnosed with ADHD last year, I began to invest in adult ADHD related research (note: ADHD is in children, It is common among teenagers and adults.).

How ADHD is produced: In fact, the cause of most mental disorders is not clear, so the cause of mental disorders is mostly described in psychiatry with factors, and the same is true for ADHD. Regarding the etiology of ADHD, the main hypotheses in terms of physiology and pathology are neurotransmitter theory and brain development disorder theory. Among them, dopamine lesions of the striatum in children with ADHD is a very classic theory. Whether it is children's ADHD[2] or adult ADHD, studies have shown that ADHD is a highly inherited familial organic disease with a heritability rate as high as 70-80%.

About the genes of ADHD: A large genome-wide association study (GWAS) on ADHD in 2018 showed that common genetic variants can explain about 30% of the genetic possibility of ADHD, and a total of 12 loci have genome-wide significance (for example: FOXP2, DUSP6, etc.). In rare cases, environmental factors can also cause ADHD or interact with genes, especially some prenatal risk factors, pregnancy stress, premature delivery, and low birth weight. In 2008, a piece of evidence on Romanian adoptees showed that children who grew up in orphanages had a much higher rate of ADHD than children grown in normal families.

In general, ADHD is mainly caused by genetics, and a small part of ADHD may be caused by the environment or the interaction between genes and the environment.

What is ADHD? Attention deficit hyperactivity disorde (hereinafter referred to as ADHD), the fifth edition of the American Diagnostic and Statistical Manual of Mental Disorders (hereinafter referred to as DSM5) classifies ADHD as a neurodevelopmental disorder, which belongs to the same category of diseases as autism and intellectual disability. Regarding the classification of ADHD, there are still controversies. DSM5 believes that there are three main manifestations of ADHD. The first one is attention deficit as the main manifestation. This type is generally called ADD (this is an earlier statement) , The second is mainly manifested by hyperactivity impulse, and the third is a mixed manifestation-both attention deficit and hyperactivity impulse symptoms. These three are generally collectively referred to as ADHD.

Regarding the symptoms of ADHD: It is divided into two parts, the first part is ADHD in children, and the second part is ADHD in adolescents & adults. Children with ADHD attention-deficient type: inability to concentrate, careless, making mistakes, listening, inattentive, losing things, distracted, forgetting, unable to complete tasks, unorganized, hyperactive, impulsive type: restlessness, twisting, difficulty sitting in a seat, running in an inappropriate environment, or Actions are too much, too much, unable to quietly play games to interrupt other people's speech
Hybrid: a combination of the first two. Adolescent and adult ADHD: Attention-deficit type: Distracted thinking and planning are often slow, talking off topic, engaging in activities that are interested or providing timely satisfaction, will show "over concentration" hyperactivity, impulsiveness: inner restlessness or restlessness, more brain Endless mental activity

The "feel seeking" behavior harms interpersonal impulsive mixed type: the combination of the first two, as you can see, as children age with ADHD, the corresponding symptoms will also change. Everyone should understand the attention deficit and hyperactivity impulse well.

However, you may not have a very idea about the characteristics of adult ADHD's inner restlessness and mental hyperactivity. Regarding the inner anxiety, let me give a personal example: I often feel that the end of the world is approaching and catastrophe is imminent. In the past, when I didn't know ADHD, I became very anxious and worried all day long. My neurasthenia had nothing to do with this, because the excessive mental activity of the brain and the muscle tension caused by it consumes the body's energy (oxygen and glucose) very much. So, for a long time, I didn't do anything every day, but yawned, lethargic, and my classmates who didn't know me thought I was taking drugs. When I fully understand the characteristics of ADHD, when I feel uneasy, I will consciously cross-confirm with a few friends to confirm whether I am in an optimistic situation, so as to gain a sense of security. In fact, this kind of inner anxiety is very necessary for entrepreneurs. It can make you feel crisis and stay vigilant against competitors. However, if the anxiety is excessive, you will inevitably sacrifice your emotional (mental) health.

Regarding mental hyperactivity, I will also give a personal example: the brain is extremely active and will think about things uncontrollably, just like being driven by an engine. Sometimes the mind will be full of various thoughts (sometimes there will be a kind of thought). To "explode" the feeling, full of thoughts jumping around). When I sleep (I sleep lightly and often wake up to find that the brain is still active), the brain is often still thinking. Note that this kind of thinking activity is not a picture of a dream or a fantasy, but a real problem thinking, and this problem may not be my concern, for example: the brain will suddenly remember how to learn guitar, and then think about the steps, We need to master which chords, learn music theory, how to press chords, etc., just like when we are awake and thinking about problems. Therefore, I often find that when I wake up, I may suddenly realize a truth and understand a solution to a problem. My classmates often said why I didn’t work so hard but improved so much? In fact, this is the "credit" of the "brain" uncontrollable, and the price behind it is the sacrifice of sleep quality (a passive reflection).

Humans have no free will in the face of genes. Later, I learned that the uncontrolled brain has a lot to do with the brain network of the default mode (DMN). The neural network of the ADHD group is over-activated, and this neural network is related to creativity, distraction, and daydreaming. Have a great relationship. Many years ago, I didn't know the ADHD gifted in fate. Actually, I had already set the price secretly.

Diagnosis and treatment of ADHD: Regarding the diagnosis of ADHD, let me start with the conclusion. As with most diagnosis of mental disorders, there is no specific physiological index that can diagnose ADHD [15]. ADHD of all ages is diagnosed mainly through consultation + scale, supplemented by some physiological indicators such as EEG, near-infrared, and blood testing. (The scales include SNAP-IV, DSM-5 screening scales, etc.). Different hospitals may use different tools for assessment and diagnosis.

In general, the diagnosis of ADHD is mainly achieved through patient self-reports, doctor interviews, and ADHD diagnostic scales to obtain the patient's symptomatic characteristics, supplemented by cross-corroboration of other physiological indicators. The treatment of ADHD is divided into two parts: drug treatment and non-drug treatment.

Let me start with the conclusion: Regarding the treatment of ADHD, studies have shown that drugs combined with other treatment methods (psychotherapy, ADHD coaching, etc.) have the best effect. Drug therapy: Currently, the first-line drug therapy for ADHD mainly includes two central stimulant drugs, methylphenidate and amphetamine. In recent years, systematic reviews and network meta-analysis studies on the treatment of ADHD drugs in children, adolescents and adults have shown that the drug of choice for ADHD in children and adolescents is methylphenidate and amphetamines for adults. The principle of the drug is still unclear. Researchers hypothesize that the drug mainly acts by inhibiting the reuptake of neurotransmitters or increasing the release of neurotransmitters such as dopamine in neuronal cell vesicles. There are other non-central stimulant drugs, such as Zestar, guanfacine, clonidine, and bupropion.

Non-drug treatment: There are mainly the following methods for the treatment of children with ADHD: sensory integration training, EEG biofeedback training, behavior modification, and mindfulness training. Regarding the treatment of adolescents and adults with ADHD, there are mainly the following methods: structured psychological education, cognitive behavioral therapy (including mindfulness and mindfulness-based cognitive therapy), and ADHD coaching.

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