Attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a motivational disorder characterized by a persistent pattern of inattention, hyperactivity, or both. It can manifest in both children and adults.

ADHD is comprised of two main subcategories: ADHD-C (Combined) and ADHD-PI (Predominantly Inactive). Formerly, ADHD-PI was sometimes known as ADD (attention deficit disorder), and this outdated terminology, while now technically incorrect, accurately describes ADHD-PI in that the patient does not experience hyperactivity, only attention deficit.

Motivation

Motivation is the main factor lacking in motivational disorders such as ADHD.

Motivational problems belong in one of two opposite categories:

• 1. Not having enough of it (for work)
  • “Lazy”, “bored”
  • Procrastination
  • Depression, ADHD, avolition in schizophrenia
• 2. Having it for the wrong things
  • Video games, ice cream
  • Staying up late, friends who make poor choices
  • Impulse control disorders
  • Gambling, heroin, sex with minors

Motivation is also influenced by biopsychosocial aspects:

• Brain-behavior relationships abound
  • Doing things changes your brain’s activity
  • Meditation changes the way your brain is wired
• Training of biological functions
  • Train many regulatory aspects of your biology (sleep, appetite, sexual response)
• Habits of thought are also trained; automatic thoughts are practiced thoughts
  • Negative and positive emotions are both trained
  • Practice what you want to be motivated towards, stop practicing what you don’t want to be motivated towards
• Emotional habits also trained
  • Generous behavior/altruistic action increases empathy

Motivation can be extrinsic or intrinsic.

• Extrinsic motivation
  • Adrenaline-based motivation
  • Fight or flight

• Intrinsic motivation
  • Fascinating topic misunderstood by most people trying to get themselves to do things like work harder at school or their jobs
  • What is reinforced outside goes inside (internalization)
    • Especially during formative years
  • Humanism - Maslow’s hierarchy of needs
  • Motivation comes from external motivation that is internalized

DSM-5 diagnosis criteria

All lettered criteria need to be met in order to diagnose someone with ADHD.

• Criterion A: A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):
  • (1) Inattention: Six or more of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. Only five or more needed for people ages 17 or older.
    • (a) Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g. overlooks of misses details, work is inaccurate)
    • (b) Often has difficulty sustaining attention in tasks or play activities (e.g. has difficulty remaining focused during lectures, conversations, or lengthy reading)
    • (c) Often does not seem to listen when spoken to directly (e.g. mind seems elsewhere, even in the absence of any obvious distraction)
    • (d) Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g. starts tasks but quickly loses focus and is easily sidetracked)
    • (e) Often has difficulty organizing tasks and activities (e.g. difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines)
    • (f) Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g. schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers)
    • (g) Often loses things necessary for tasks or activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
    • (h) Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts)
    • (i) Is often forgetful in daily activities (e.g. doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments)
  • (2) Hyperactivity and impulsivity: Six or more of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. Only five or more needed for people ages 17 or older.
    • (a) Often fidgets with or taps hands or feet or squirms in seat
    • (b) Often leaves seat in situations when remaining seated is expected
    • (c) Often runs about or climbs in situations when it is inappropriate
      • Adolescents and adults: may be limited to only feeling restless
    • (d) Often unable to play or engage in leisure activities quietly
    • (e) Is often “on the go”, acting as if “driven by a motor” (e.g. unable to be or uncomfortable with being still for extended time, as in restaurants, meetings; may be seen by others as being restless or difficult to keep up with)
    • (f) Often talks excessively
    • (g) Often blurts out answers before a question has been completed
    • (h) Often has difficulty waiting their turn
    • (i) Often interrupts or intrudes on others (e.g. butts into conversations, uses things without permission)
• Criterion B: Several inattentive or hyperactive-impulsive symptoms were present before age 12
• Criterion C: Several inattentive or hyperactive-impulsive symptoms were present in two or more settings
• Criterion D: There must be clear evidence that the symptoms interfere with, or reduce the quality of, social academic, or occupational functioning
• Criterion E: 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, personality disorder, substance intoxication, or withdrawal)

If subcriterion A(1) is met but A(2) is not met, the subtype of ADHD is ADHD-PI. If both subcriterion A(1) and A(2) are met, then the subtype of ADHD is ADHD-C.

Treatment

ADHD itself has no cure, but strategies to mitigate and improve the quality of life for ADHD patients exist.

ADHD can be managed with medications. Psychiatrists and other doctors can prescribe dextroamphetamine (Adderall) or lisdexamfetamine (Vyvanse) to improve one's motivation and ability to pay attention.