Synopsis
A neurocognitive behavioral developmental disease, attention deficit hyperactivity disorder (ADHD) is most frequently observed in childhood and adolescence and frequently persists into adulthood. In comparison to 10 years ago, a great deal more study has been done to identify the underlying causes of ADHD, which has resulted in a greater variety of treatment options for both adults and adolescents with this illness. Thanks to innovative formulations of stimulants, patients can now customize their medication to last as long as they need, while also reducing the risk of addiction, overuse, and distraction. Over the past few years, a number of fresh non-stimulant choices have also surfaced. Among these, cognitive behavioral therapies have shown to be effective in treating adult ADHD, particularly in the group of adults who refuse or are unable to take medication, as well as in the numerous people who get medication but nevertheless exhibit residual disability.
Overview
The neurobehavioral condition known as attention deficit hyperactivity disorder (ADHD) is characterized by recurrent, maladaptive symptoms of inattention and hyperactivity/impulsivity [1] (diagnostic criteria are shown in Table 1). Serious impairments in intellectual, social, and interpersonal functioning are common in those with ADHD. In addition, a number of comorbid illnesses and disorders, including mood disorders, disruptive behavior disorders, and learning difficulties, are linked to ADHD. Current theories of the origins of ADHD and developments in treatment will be reviewed in this study, along with considerations of stimulant and non-stimulant medication and cognitive behavioral therapy (CBT).
Recognizing ADHD
According to earlier estimates, 3 to 5% of school-age children and 4 to 5% of adults have ADHD . However, more recent research has moved the proportion closer to 7 to 8% of school-age children and adults. The prevalence obviously varies, and risk factors include living in an urban area, being a man, being older, having long-term health issues, having a dysfunctional family, having a low socioeconomic position, and having a developmental disability [4]. All of the assessed countries had rates of the disease that are comparable to, if not higher than, those in North America. Although differences across ethnic groups in North America are occasionally observed, socioeconomic status appears to have a greater influence on these differences than ethnicity. ADHD may actually be the most severe end of a normal continuum for the qualities of inhibition, motor activity regulation, and attention, while being classified as a category condition.
Recent developments in behavioral and molecular genetics, cognitive neuroscience, and neuroimaging have demonstrated that ADHD is a complex neurological condition. Multiple brain areas and a number of neurotransmitters have been linked to ADHD. Dopamine has drawn a lot of interest in the biological literature as a neurotransmitter that may be useful in understanding ADHD. The prefrontal cortex appears to have a role in comprehending ADHD from a neurological standpoint. Dopamine is highly required by the prefrontal cortex, which is involved in cognitive processes like executive functions. Numerous reciprocal connections exist between the prefrontal cortex and other brain regions, such as the cerebellum, parietal cortex, and striatum (caudate nucleus, putamen). Studies have shown that individuals with ADHD may have slightly smaller brain areas or lower activation in several of these regions.
Conditions that coexist
Mood, anxiety, and disruptive behavioral problems are among the many mental diseases that frequently co-occur with pediatric ADHD. Similarly, diagnosis of comorbid mood, anxiety, and substance-use disorders are linked to adult ADHD. Gender has no bearing on the comorbidity rates of adult ADHD. Adult ADHD is not usually co-occurring with other mental health disorders, and some research indicates that 20–25% of adults with ADHD have "uncomplicated" ADHD .
Present-day studies
Over the previous 30 years, research on ADH has been published at an exponential rate [19]. Theories on the cause of ADHD and its treatments have developed in tandem during the last three years, starting in 2008. In the treatment of ADHD, psychopharmacological drugs that impact catecholaminergic and α-2-adrenergic transmission remain a significant component. But in the last three years, there has been a greater focus on prescription practices, drug matching to patient characteristics, and treatment adherence-promoting variables for pediatric and young adult populations. The available treatments for ADHD in adults and children will be covered in the section that follows.
therapies for ADHD
For both adults and children, there are pharmacological and non-pharmacological treatments for ADHD. The most popular therapy methods are pharmacological ones, which usually involve stimulant drugs like lisdexamfetamine dimesylate (LDX), methylphenidate, dexmethylphenidate, and mixed amphetamine salts. Nevertheless, it has also been discovered that non-stimulants such guanfacine, atomoxetine, and clonidine are effective in treating ADHD. Apart from pharmaceuticals, non-pharmacological treatments also exist. There are currently many medications covered in this section that are only authorized for use in North America.
In order to lessen the problem behaviors linked to ADHD, parents and teachers who work with children diagnosed with ADHD must get training in appropriate behavior-management approaches. For adults with ADHD, CBT is a skill-based technique that is frequently utilized, and some early research indicates that it is effective.
Incentives
Stimulants continue to be the first choice for medication management for the majority of ADHD patients since meta-analyses of the available data have demonstrated their superior efficacy over non-stimulant medicines. There are numerous delivery methods available. Medical professionals can select from a variety of delivery methods for these stimulants, including liquid, sprinkle, tablet, capsule, or patch; pro-drug; active isomer; combinations of active and less active isomers; and formulations with immediate, intermediate, or delayed release. There are several options available for both the methylphenidate and amphetamine families, allowing clinicians to better customize the length of medication efficacy throughout the day to meet the needs of the individual.
Treatment for ADHD in adults
There has been discussion in the past over the necessity of therapy for adults with ADHD due to reports of abuse, distraction, and subpar response. An increasing amount of research is being done on the treatment, and evidence-based guidelines have been developed recently. Stimulant drugs work better than non-stimulant drugs for treating adult ADHD, according to a meta-analysis of pharmacological agents. This is consistent with ADHD in children, for which stimulants are likewise typically regarded as the first line of treatment. Stimulants are typically regarded as the first line of treatment for adult ADHD, much like they are for pediatric ADHD. All of the FDA-approved medications for treating adult ADHD are long-acting, in contrast to those for childhood ADHD. Remarkably, studies indicate that only 49% of adults receive prescriptions for long-acting medications]. Compared to children, the percentage of adults using long-acting medicines is significantly lower.
Though adults with ADHD are more likely to use bupropion and modafinil than children, non-stimulant choices are comparable to those for juvenile ADHD. Atomoxetine, however, is the only non-stimulant medication approved by the FDA for use in adults with ADHD.
Adults may be more susceptible to abuse and diversion than children because parents may be in charge of their children's prescriptions. Misuse of stimulants appears to be more prevalent in people with co-occurring drug, alcohol, and tobacco use issues as well as in people who exhibit more severe symptoms of ADHD. Furthermore, compared to short-acting stimulants, long-acting stimulants are less likely to be abused or diverted.
When treating pediatric ADHD, a combined treatment approach typically includes medication and some type of psychosocial intervention, which might include working one-on-one with the kid, consulting with teachers and other school staff, and teaching parents behavioral management skills. In spite of co-occurring attentional/hyperactive issues, behavioral parent training (BPT) programs appear to be beneficial for children exhibiting disruptive behaviors. Generally speaking, behavior modification therapy (BPT) involves teaching parents about basic operant conditioning methods, like conditionally applying reinforcement or punishment based on suitable or inappropriate behavior. In contrast to punishment techniques, which typically involve official "time outs" from reinforcement or the loss of positive attention, reinforcement processes have traditionally depended on praise, privileges, or tokens.
Similar to children, adults receiving combination treatment often include both psychosocial intervention and medication. Nonetheless, in contrast to ADHD in children, there is some evidence that CBT therapies are effective..
