A fairly common neurodevelopmental disorder/ShutterStock
What is attention deficit disorder?
"Attention-deficit/hyperactivity disorder (ADHD) is a fairly common neurodevelopmental disorder. It usually begins in childhood, but it exists at any age. It is currently assumed that about two-thirds of children will "continue" with the disorder into adulthood. It is worth noting that there is also a hereditary component," explains Dr. Roi On, an expert in adult psychiatry and deputy director of the psychiatric department at the Ichilov Hospital.
"In an article published in one of the leading medical journals (The Lancet Journal) in 2022, it was found that the rate of ADHD among The population of children and youth hovers around 5.3%," explains Dr. Tomer Levy, a child and youth psychiatrist and expert adult psychiatrist, director of the clinic for behavior regulation and the parent-child relationship at the Gaha Center for Mental Health, from the Hakhalit group.
"Data from the American Center for Disease Control, as well as published findings from a sample of those insured by the general government, indicate that by puberty over 10% of adolescents over the age of 12 will be diagnosed with attention deficit disorder. At least two-thirds of the children and youth who were diagnosed with this disorder in their youth will continue to face functional difficulties arising from from their remaining attention and concentration difficulties. The prevalence of attention disorder in adults is around 2.5%. These cases include not only those children and teenagers who exhibited symptoms of attention disorder in their youth. Today there is evidence indicating that there may be people in whom the symptoms of attention disorder may be found after age 12 or even in matriculation".
Dr. Levy clarifies that "there are many studies linking the existence of attention deficit disorder in the young to a negative medical outlook in the older age, across multiple mental and functional areas.
In the absence of an experienced doctor to clarify these findings, parents and children may mistakenly think that every child diagnosed with ADHD is bound to suffer from academic, interpersonal and other functional difficulties, mental disorders, physical illnesses, and even premature death.
Such a message leads to anxiety, confusion and ultimately, to a loss of trust in caregivers and resistance to treatment among parents and children, and rightfully so.
It is important to understand that an individual's development trajectory is influenced by a huge number of factors, and it is not possible to predict for each boy or girl how and where they will develop."
What are the symptoms of attention deficit disorder?
" The main symptoms of
attention
deficit disorder are divided into three main areas: attention and concentration difficulties, hyperactivity (overactivity) and impulsivity," explains Dr. On
. A long-term task, a tendency to avoid activities that require prolonged mental effort, procrastination, difficulty in order and organization, difficulty finishing tasks on time, a tendency to forgetfulness on a daily basis, a tendency to lose small objects such as keys/cellphone/wallet, etc., a tendency to lack attention to small details.
Usually these people also get comments that they don't seem attentive when you talk to them," explains Dr. On.
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In the field of hyperactivity
this is often expressed in restlessness, people who move their legs and/or fidget with their hands, difficulty sitting for long periods of time, feeling the urge to get up and move around, difficulty enjoying quiet and static activities, a tendency to be in constant activity and a tendency to talk a lot.
In the field of impulsivity
this can be expressed in a tendency to answer questions before they are finished, to burst out in the middle of a sentence, to "interfere/harass" other people when they are busy and difficulty waiting in line (in addition to the fact that we are Israelis).
It is important to emphasize that not all of the described symptoms must appear in order to meet the criteria of the diagnosis."
In most cases in the older ages the expression will be more refined/ShutterStock
Are there differences between children and adults?
"In most cases, the clinical manifestations will already appear in childhood, but they can continue to accompany the person even in adulthood. Of course, at any age, the manifestation can be different," explains Dr. On. In most cases, in the
older ages, the manifestation will be more refined, especially in the area of hyperactivity and impulsivity. The same hyperactive child who ran, jumped and climbed trees as a child, today when he is a senior employee in a company, he will find it difficult to sit in meetings for a long time, interrupt people and "make up different excuses" why he needs to get up and leave the room. Of course, as the person grows older, he adapts different methods and ways to compensate and deal with the symptoms."
"As described, with the transition to adulthood, there was a benefit in the extroverted symptoms of the attention disorder," adds Dr. Levy. "There was a more noticeable improvement in the symptoms of impulsivity and hyperactivity, which might have led to socially inappropriate behavior.
In adults, impulsivity and hyperactivity may be more internalized, and manifest more prominently in difficulties in emotional regulation and inner restlessness."
According to him, despite the growing awareness of the manifestations of attention deficit disorder in adults, it is possible that there is still an underdiagnosis of attention deficit disorder in this population. "Adults may develop mechanisms More effective compensation for attention difficulties, for example memorization, use of aids and working in groups in academic studies.
Still, the study demonstrates that adults who no longer meet the full criteria for childhood attention deficit disorder continue to suffer significant functional impairment.
In light of these findings, the criteria for diagnosing attention deficit disorder in adults were somewhat relaxed about a decade ago.
It is very important to note that in adults, attention deficit disorder may have an impact on other functional methods such as marital relations, functioning at work and work relations, as well as on parenting."
What effects do people with attention deficit disorder have?
"Attention deficit disorder has functional consequences for all areas of life. The disorder may harm studies, work, interpersonal relationships, social interactions, relationships and family functioning," explains Dr. On.
One of the common consequences is impairment of a person's administrative functions, which are essentially a collection of cognitive skills are high which allow us to control and control our behavior, thoughts and emotions. These abilities include, among others, planning and organization, regulating behavior, regulating emotions, the ability to initiate, the ability to delay a response, mental flexibility, attention and working memory."
As you can understand, the damage to these administrative functions can affect our functioning in all areas of life.
How is attention deficit disorder diagnosed?
"The diagnosis of attention deficit disorder is a clinical diagnosis. It is made by an expert doctor in the field, usually psychiatrists/neurologists/family doctors who have undergone specialization in the subject. It is important to note that today there are several computerized tests such as TOVA or MOXO, which are tests that usually check response to drug treatment , but are not mandatory in the process of diagnosis," explains Dr. On.
Box of Ritalin pills/GettyImages
What treatment is available and for whom it is suitable
"The most effective treatment for attention deficit disorder is medication," explains Dr. On. "Today, there is a variety of medication treatments that can help and improve the function and quality of life of those diagnosed.
Drug treatment for attention disorders is given only after diagnosis and only by a specialist doctor.
It is important to adjust the drug treatment according to the unique characteristics and needs of each patient.
In certain situations of intolerable side effects or concomitant psychiatric morbidity, second-line drugs from other families can be used."
Dr. Levy emphasizes that "clinicians working in the field meet every day a large number of children, teenagers and adults whose attention disorder treatment using various drugs leads to an improvement in symptoms, functional and to improve the quality of life of the child. There is much evidence indicating that the treatment of attention deficit disorder may lead to an improvement in the patient's prognosis in the future, in a wide variety of areas. Therefore, in situations where we meet children and teenagers with attention deficit disorder that leads to significant functional impairment, we We find it appropriate to recommend non-medicinal and medicinal treatments for attention disorder."
He adds that "the non-pharmacological treatment may be effective for functional improvement and the accompanying symptoms of attention disorder in children and teenagers. There are evidence-supported developments of non-pharmacological treatments for attention disorder for young people and adults. It is important to find out about the certification of the therapists, the treatment methods, and their experience in the field. A "stimulant" drug such as methylphenidate (Ritalin, under its trade name), which is in the first line of treatment, is effective in reducing symptoms in children, teenagers, adults, and to a lesser extent, in children under preschool age."
Side effects of drugs for the treatment of attention
According to Dr. Levy, "the side effects in children and teenagers are similar to those of adults.
Common among them are a decrease in appetite, difficulty sleeping and nausea."
"I am often asked whether a child who has started taking medication for attention disorder will continue to take the medication for the rest of his life.
An article published in 2017 and compiled over 16 years confirms the accumulated impressions I have.
In this study they found that over 90% of the hundreds of children who started the study when they were between 9 on average, did not continue to take the medicine consistently throughout the following years.
Along with the possibility that this finding points to undertreatment of ADHD, I think that this finding can reassure patients when they come to choose the drug treatment, knowing that even after starting to take the drug, they will be able to continue to consider without fear whether the drug is necessary and whether its benefits outweigh the prices that come with it."
Final highlights
"Attention deficit disorder is a common disorder that can cause functional impairment in various areas of life. People can go through an entire life without being aware that they suffer from attention deficit disorder, which can cause great frustration. Awareness of the diagnosis is important," concludes Dr. On.
"Together However, many other mental/behavioral symptoms can be misleading and manifest as symptoms that are similar to those of ADHD.
This is especially important in people who have co-morbid mental illness such as mood disorders, post-traumatic symptoms, anxiety disorders and psychotic conditions.
Therefore, it is always recommended to consult a professional in order to arrive at the correct diagnosis and adjust the most appropriate treatment for each person."
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