Attention Deficit Hyperactive Disorder or ADHD is a condition that is being diagnosed more and more these days.
The number of children diagnosed with ADHD is 6.1 million or 9.4% of children.
Of these numbers, more than half of the children diagnosed with ADHD were between the ages of 12-17 years old.
A study looking at the trends of ADHD diagnosis from 1997-2016 found that the prevalence of ADHD diagnosis has significantly increased between the years 1997-1998 and 2015-2016.
ADHD presents differently in boys and girls. Boys are more likely to be diagnosed with ADHD than girls (12.9% vs 5.6%).
The expansion of medical education allowed doctors to understand the different presentations this condition can have. This led to more girls being diagnosed as they don’t often show symptoms of hyperactivity.
A potential reason why girls are diagnosed less is due to a phenomenon called “masking”. This term was coined by a psychologist named Russell Barkley.
Masking is a form of “social camouflage” in which people with ADHD try to show others that they either do not have the disorder or, if they do have it, try to show that it is under their control.
What Is ADHD?
There are three subtypes of ADHD.
- Predominantly inattentive
- Predominantly hyperactive
- A combination of the two
You may have heard of the term ADD to describe ADHD. Before the updated guidelines of ADHD diagnosis, ADD referred to the inattentive form of ADHD.
However, ADD is no longer used to describe ADHD. Instead ADD falls under the umbrella of ADHD. The focus is now on which symptoms are predominately shown as opposed to creating mutually exclusive categories.
The percentage of individuals that have the predominantly inattentive subtypes is 18.3% of total patients, the predominantly hyperactive subtype is 8.3% of total patients and a combination of both represents 73.4% of total patients.
As you can see, if you fall into the predominantly inattentive subtype you are more likely to fall through the cracks and live with the condition undiagnosed.
ADHD has a 40-60% persistence into adulthood and a prevalence of 2-3%. This means that as many as half of children will outgrow their ADHD symptoms!
The symptoms that are often outgrown are the hyperactive ones but the symptoms that often stay into adulthood are the inattentive ones.
What Are The Symptoms Of ADHD?
Symptoms of ADHD begin at a young age and include
- A lack of attention
- Lack of concentration
- Difficulty completing tasks
- Being forgetful
- Constantly losing things
- Emotional dysregulation
Now these symptoms can happen in neurotypical individuals but for it to be labelled as ADHD they must
- Be present before the age of 12
- Last at least 6 months
- Interfere with daily activities
All of these symptoms relate to a set of mental skills called executive function. An executive function consists of
This skill allows us to receive information without losing track of the task we are currently completing. This form of memory allows us to hold new information in place, work with it, then connect it to other information.
This mental skill relates to the ability of our brains to switch our attention or through the process to either new information presented to us or new rules. It is what is responsible for allowing us to “think on our feet” and switch gears very quickly to solve problems.
Inhibitory control is responsible for us being able to suppress or countermand a thought, action or feeling in favour of more appropriate action.
Overall, executive functions are the necessary skills that allow us to learn every day, adapt to our environment and manage life. Even simple tasks such as cooking and cleaning are powered by executive functions!
What Causes ADHD?
ADHD has a high rate of heritability (74%). This means that if your parent has it (diagnosed or not) there is a high probability that you will have it.
There still is a portion of environmental causes that can lead to ADHD. These risk factors include:
- Brain Injury
- Exposure To Environmental Toxins During Pregnancy Or a Young Age
- Alcohol And Tobacco Use During Pregnancy
- Premature Delivery
- Low Birth Weight
But what are the genetic differences between a neurotypical person and a person with ADHD?
People with ADHD have dysfunctions in their dopaminergic system in the brain. What this means is that doctors believe that ADHD is caused by a lack of dopamine.
Dopamine plays a very important role in learning, memory, cognition, movement and emotion.
Based on genetic studies, there are two genes (among many others) that have been identified as ADHD risk factors which are the DRD4 and DAT1 genes. Changes to these genes can be responsible for the emotional dysregulation and impulsivity associated with ADHD.
These genes are responsible for dopamine transporters which are in charge of removing dopamine from the brain. People with ADHD have higher concentrations of these transporters in their brain which could explain why they have lower levels of dopamine!
The current treatments seek to increase dopamine levels in the brain.
How Is ADHD Diagnosed?
ADHD has a lot of overlaps with other mood disorders such as borderline personality disorder, autism, anxiety and depression.
ADHD is a clinical diagnosis meaning that you can’t do a brain scan or standard lab tests to determine if you have it. A diagnostic tool used to diagnose ADHD in children from 6-12 is called the Vanderbilt ADHD scale. It involves both parents and teachers filling out a form rating various ADHD symptoms by severity.
One of the most important things to do for an ADHD diagnosis is to determine what it is not. What this means is eliminating other mood disorders.
“Mood disorders such as depression and anxiety can be misdiagnosed in people who have ADHD!”
For a diagnosis to be made it involves checking with a doctor to rule out any physical health issues. Afterwards, if the person is believed to have the condition they can get referred to a specialized psychiatrist who is capable of making a clinical diagnosis.
Afterwards, a treatment plan is developed to help them manage their ADHD symptoms.
There are three types of treatment for ADHD. Two forms of treatment involve medication while the third form is psychotherapy.
It seems odd to give a person that is already hyperactive a stimulant. Wouldn’t that give them more energy? This is a bit more complicated than it seems. If insufficient dopamine levels are the cause of ADHD then a reasonable treatment is to increase these levels.
“Stimulants are designed to increase dopamine levels in the brain”
Stimulants are broken into two classes which are amphetamines and methylphenidate. Drugs in the amphetamines class are chemically similar to the drug methamphetamine or meth.
Both of these drug classes block dopamine transporters from removing dopamine but amphetamines also have another function which is to directly release dopamine.
On the other hand, non-stimulants target a different chemical called norepinephrine. The reason they target norepinephrine is that it plays an important role in executive function.
“Executive function is what allows you to start and complete tasks”
The issue with this class of medication is that it does not have the 70-80% success rate of stimulants. The only reason that a doctor may switch to a non-stimulant is if the side effects are bad or the medication is not working.
Psychotherapy is often used in combination with medication to help with the management of this disorder. This treatment involves education for the patient and their family as well as training programs designed to help the patient achieve both short-term and long-term goals.
What Is Insomnia?
Insomnia is characterized by difficulties
- Falling asleep
- Staying asleep
- Going back to sleep after waking up during the night
- Feeling tired after sleeping
There is no set definition for insomnia but instead relies on individual subjective interpretations of sleep difficulties.
Can ADHD Cause Insomnia?
ADHD can cause disordered or disturbed sleep. A potential reason behind this phenomenon is that ADHD is associated with disturbances in circadian rhythm.
ADHD can cause a delayed release of melatonin (the hormone responsible for allowing you to get to sleep and stay asleep). This can make individuals with ADHD more likely to be “night owls”.
That being said, there are three models of how ADHD can impact sleep.
Model 1: ADHD Leading to Sleep Problems
In this model, ADHD symptoms lead to sleep disturbances and thus treating ADHD may alleviate the issue.
Model 2: Interaction
ADHD leads to comorbidity such as depression or anxiety that in turn leads to a sleep problem. This sleep problem then exacerbates ADHD symptoms making the patient’s depression or anxiety worse.
The treatment for this model is treating the underlying cause of the sleep problem as well as ADHD.
Model 3: Sleep Problem Leading to ADHD symptoms
Sleep problems can cause ADHD-like symptoms and thus treating this sleep disorder may alleviate the issue.
“In a 2021 study published in the Frontiers in Psychiatry Journal, researchers found that 44.4% of adults with ADHD had insomnia”.
Researchers also found that
- 63.9% of adults with ADHD had insomnia symptoms but did not meet enough criteria to be diagnosed with the disorder.
- Adults taking ADHD stimulant treatment had lower rates of insomnia compared to adults not taking any medication.
Natural Sleep Aid For ADHD Adults
One of the most difficult issues with helping people with ADHD improve their sleep is asking them to adopt new habits as they often struggle to change their behaviour and follow through on their plans.
As such, accommodations are necessary to help with planning, task switching and organising challenges associated with the plan.
In order to help adults with ADHD sleep the first thing that should be prioritized is their comorbid conditions such as anxiety and/or depression.
That being said, some natural sleep aids for ADHD adults include
Creating A Good Sleep Environment And Routine
Sleeping in complete darkness can help individuals with ADHD (children or adults) as it helps with the production of melatonin.
Individuals with ADHD are more likely to be night owls, but despite this, avoiding blue light is best for sleep.
Exercise can help alleviate hyperactivity as well as symptoms of anxiety and/or depression in adults with ADHD.
Ensure that exercise is not done directly before bed as that could be counter productive.
Short-term use of melatonin has been found to be safe and can help promote sleep if taken before bedtime.
Light therapy is considered a low risk treatment that has been shown to improve sleep in adults that have ADHD. This form of therapy helped increase melatonin levels earlier at night.
What Is ADHD Fatigue Syndrome?
Fatigue syndrome or chronic fatigue syndrome (CFS) is a disorder that is associated with extreme fatigue that can cause physical and mental impairment. This can directly reduce quality of life.
ADHD is highly prevalent in people that have CFS! This association suggests that ADHD could be a risk factor for developing this disorder!
One hypothesis for this is that ADHD is associated with other comorbidities such as anxiety and depression. These comorbidities have been described as risk factors for CFS.
A second hypothesis for this is based on believing that CFS is a stress-related disorder. ADHD is a chronic disorder that can lead to lots of stress which in turn could be a risk factor for CFS!
A third hypothesis is that the dopamine system dysfunction seen in people with ADHD has also been observed in people with CFS.
Overall, there is no clear link or reason why people with ADHD develop CFS, however, observations have noticed similarities between the two disorders. There needs to be more research conducted on this association!
Now We Want To Hear From You!
Which statistic shocked you the most?
Are you surprised by the link between ADHD and insomnia? If so, what surprises you the most?
Leave a comment down below!