Attention Deficit Hyperactivity Disorder (ADHD) – an accompanying and “imposturous” causes
Dr. Daniel Ben Eliezer, Chief psychologist, Excellent Brain
Attention Deficit Hyperactivity Disorder (ADHD) is a developmental disorder (starts in early childhood) and is extremely common. Nevertheless, it is often associated with a variety of disorders and comorbidities such as mood disorders, social difficulties, and anxiety.
However, the relationship between the various disorders and ADHD is complex, and in the following article we will review several different types of relationships:
A. Disorders related to attention deficit disorder that are likely to emerge from a common organic-neurological basis
B. Disorders related to ADHD mainly due to the drug treatment (i.e., side effects)
C. Disorders that are sometimes associated with ADHD, which are mainly caused by its non-binding consequences (i.e., do not always occur, and can be treated separately)
D. Disorders that pretend to be ADHD, that is, they are independent disorders, and they may cause symptoms similar to ADHD thus may be misleading in diagnosis or treatment (if there is an ADHD regardless of them, they may increase its symptomatic severity).
A. Disorders related to attention deficit disorder emerging from a common organic basis
These cases are few and involve a neurological (brain) basis that causes attention disorders, associated with underactivity in neural circuits associated with the prefrontal region and reward areas and movement planning in the brain (such as the striatum and cerebellum, respectively). But in this case, these irregularities in the brain are also related to other disorders like sensory regulation and sometimes there are additional, or more extensive, irregularities, which are also related to other developmental disorders, motor disabilities, learning disabilities or communication disorders (among them: tic disorders, mild communication disorders).
In these cases, ADHD does not cause the other disorder, but they coexist, due to neurological-organic foundation. In adjusting the treatment (pharmacological or neurofeedback) both disorders should be considered and addressed, while sometimes prioritizing the more acute one. This consideration is important because providing an intervention to one disorder will not always provide the best solution to the additional illness.
B. Disorders related to attention deficit disorder mainly around drug treatment (i.e., side effects)
These cases may be more common than it seems. The most common medications for attention deficit disorders are stimulant drugs that delay the reuptake of dopamine and norepinephrine in certain synapses in the brain, thus causing a stronger effect on attentional cycles. The most common drugs are methylphenidate (Ritalin, Concerta), and amphetamine (Vivans, Adrel, Attent). These drugs have a stimulant effect, that is, cause overactivity of systems in the body, including stress-related systems such as the autonomic nervous system (the sympathetic branch). Considering these reactions, there may be side effects of the medication, including – hyperarousal (difficulty falling asleep), feelings of stress and anxiety, palpitations, gastrointestinal underactivity, appetite suppression, and consequences of all these over time – including hypertension and other factors. Sometimes an unadjusted dose can also cause the opposite reaction such as drowsiness and “zombies”. Although the drugs are common and relatively safe, it is very essential to consult a doctor who is qualified to diagnose and treat attention deficit disorders, and in particular a psychiatrist or neurologist – who may adjust or replace the drug treatment, which can sometimes help.
In addition, some medicines contain milk sugar (lactose), so for many people it can cause digestive problems.
C. Disorders that are sometimes associated with ADHD, which are mainly caused by its non-binding consequences
In this case, these are symptoms that are indirectly caused by ADHD, but do not always occur , and can be treated separately.
For example, ADHD, especially when left untreated, can make it difficult to learn and persevere in activities, and therefore making it difficult to integrate into games and social activities; – hence can cause social rejection (or loneliness), social anxiety and mood disorders (depression).
Another example could be a learning difficulty that causes a lower self esteem (and this, in turn can lead to depression). Of course, even in moderate cases, when there is no depression or other disorder, the impairment still can be significant and cause difficulties in social, academic, marital or occupational functioning.
In this case, the psychological state should be reconciled and should be treated. In some cases (such as social anxiety, depression, low self-esteem), when the comorbidity is well-established and significant, treatment for ADHD alone will not be optimal, as the additional symptoms have already been established. Thus, it is advisable to treat the negative outcome separately (for example: treatment of self-esteem or treatment of depression), and independently treat the ADHD. In mild cases, treatment of attention deficit disorders may reduce the associated morbidity, but it is mandatory to be accompanied by a professional (physician or psychologist) to assess the priority of treatment according to the severity of the various cooccurring disorders.
It is important , however, to note that the comorbidity of this type is not a fate, and is not a necessary by-product of ADHD. Various emotional interventions can help to prevent or reduce the odds of developing this type of comorbidity, even if the ADHD is left untreated.
Another case of comorbidity is in cases of untreated ADHD, in which the person often develops a coping strategy of self-induced stress, which may lead to chronic stress and its accompanying symptoms. In a separate article (“Attention Deficit Disorder, stress , and everything in between them”) I reviewed this phenomenon in detail.
D. Disorders that “imposter” ADHD
There are many background factors that impair attention and are not related to ADHD. That is, when they exist, the person will display characteristics as if she or he has ADHD, but in practice they do not. Of course, there may be cases where there is an attention deficit disorder in the background (at different severity levels), and these additional factors will aggravate the symptoms.
Keep in mind that ADHD is developmental, that is, begins in early childhood, and any significant “exacerbation” of ADHD symptoms, will hint at another, different factor that causes them – and not the ADHD itself – that should not worsen by its own.
In this context, here is a long list of factors that may impair attention, and therefore present similarly to ADHD symptoms
- Physiological factors – hormonal changes, including sex hormones and a change in thyroid activity.
- Nutrition – Deficiencies in essential nutrients such as B vitamins (including folic acid-B12) and iron, as well as cases of malnutrition that causes a lack of availability of blood sugars.
- Sleep disorders – one-time lack of sleep, chronic lack of sleep, and impaired sleep quality.
- Anxiety and stress – especially in cases where there are disturbing thoughts (mental ruminations) that occupy the person’s working memory (“take over the mind”) and interfere with producing clear thought and concentrating, of course post-trauma cases are an extreme example of this.
- Mood disorders – mainly depression
- Chronic pain or other continuous stimulation of our senses (as tinnitus) which also occupy the working memory.
- Neurological factors – whether those that change during life (with an emphasis on degenerative processes in old age), as well as various developmental disorders that are not attention disorders, but similar.Drugs that inhibit the nervous system – including sedatives (mainly from the benzodiazepine family – to which most sedatives belong), some anti-psychotic drugs, and a wide variety of other drugs.
Of course there may be other factors. In any case of a change in attention, it is important in the diagnostic process to examine the full course of life – what happened around the period in which the attention was impaired. For example – a birth of a child (and consequentially, impaired quality of sleep)? Is the student enrolled in a class that takes place late in the evening? Was there a traumatic event? Have you started a new drug treatment? A change in diet?
In any case, a good professional will evaluate, as part of a diagnosis, most of these factors. It is therefore also important to consult with the attending physician (family / children) regarding periodic checkups, and if necessary consult with a relevant professional (such as a nutritionist) as well as another qualified therapist (such as a psychologist).
In conclusion
ADHD is a common and complex disorder, but its relation to other disorders and ailments is complex and multifaceted. It is therefore very important to consult with professionals who are experts in the field (doctors or psychologists who specialize in this) before deciding on treatment.
This article is intended to provide general knowledge and understanding about attention deficit disorders, it is not medical advice, and has no substitute for advice, diagnosis or individualized treatment done by a certified professional.
