ADHD - Attention deficit disorder with or without hyperactivity

ADHD symptoms fall into two main categories: inattention and hyperactivity/impulsivity. These symptoms can appear very early, sometimes before the age of three. To make a reliable diagnosis, these symptoms must significantly disrupt daily life in at least two distinct environments, such as at home and at school.
Inattention is manifested by difficulty concentrating on details or following a task through to completion. ADHD patients often seem distant, as if absorbed in their thoughts, and have difficulty organizing their work or daily activities. At the same time, hyperactivity is expressed by a constant need to move or talk, often in contexts where this is inappropriate, while impulsivity leads to hasty actions without thinking through the consequences.

These symptoms, although present in everyone at different times, become pathological when they exceed the limits of what is expected for the individual's age and level of development.

Although the exact causes of ADHD are not fully understood, research points to a complex interaction between genetic, environmental and neurological factors. The genetic dimension plays an important role, as ADHD tends to run in families. Studies suggest that variations in certain genes linked to the dopaminergic system may increase susceptibility to ADHD.

Environmental factors, such as prenatal exposure to alcohol, tobacco or drugs, also increase the risk. In addition, toxins such as lead, often present in poor environments, can have a negative impact on neurological development. Finally, abnormalities in brain development, particularly in the prefrontal cortex, play an important role in the onset of symptoms.

Certain conditions increase the likelihood of developing ADHD. A family history of psychiatric disorders, premature birth or low birth weight are among the most common risk factors. Children exposed to stressful or unstable environments are also more likely to develop the disorder.

Diagnosing ADHD is a complex process based on a thorough clinical assessment. There is no biological test to identify this disorder, which makes the clinician's expertise essential. The assessment includes interviews with parents, teachers and sometimes the child him/herself, to gather information about symptoms in different contexts.

In Switzerland, the DSM-5 and WHO ICD 10/11 diagnostic criteria require the presence of symptoms of inattention or hyperactivity/impulsivity for children (five for adults), for a minimum duration of six months. These symptoms must cause significant discomfort and not be better explained by another mental or medical disorder.

The treatment of ADHD differs between children and adults, due to the different needs and therapeutic approaches adapted to each age group. A multimodal approach, combining pharmacological and psychosocial interventions, is recommended in both cases.

Children

In children, treatment is based on interventions designed to meet their developmental needs and their family and school environment. Psycho-education plays a fundamental role, informing children, their parents and teachers about the nature of ADHD and strategies for managing symptoms on a day-to-day basis.

Behavioral interventions, such as positive reinforcement programs, are often the first line of defense. They help to encourage appropriate behavior, structure activities and teach the child emotional regulation and attention management strategies. These approaches need to be coordinated between parents and teachers to ensure continuity.

When symptoms are severe or psychosocial interventions alone are not enough, pharmacotherapy becomes necessary. Stimulant drugs such as methylphenidate and lisdexamfetamine are the most frequently prescribed, with proven efficacy in improving attention and reducing hyperactivity. These treatments require rigorous monitoring to adjust doses and avoid side effects.

Adults

In adults, treatment often begins with a thorough assessment to establish priorities, particularly in the case of co-morbidities such as depression, anxiety or sleep disorders. Psycho-education is essential to help patients understand their diagnosis and accept the proposed management strategies.

Pharmacotherapy is a mainstay of treatment in adults, with methylphenidate the first choice, followed by dexmethylphenidate, lisdexamfetamine and atomoxetine. These drugs act on neurotransmitters to reduce symptoms. In some cases, patients prefer not to use medication or have contraindications. In these cases, psychosocial interventions such as coaching or cognitive-behavioral therapies become an important alternative.

These interventions focus on managing residual symptoms, organizing tasks, regulating emotions and improving attention. Group or individual therapies are often effective in reinforcing the strategies learned. Finally, the main aim of adult treatment remains to improve quality of life and reduce the subjective suffering associated with the functional limitations of ADHD.

Common approach to both groups

In all cases, regular assessment of the effectiveness of the treatment is essential in order to adjust strategies. Collaboration between specialists, family members and the patient is crucial to maximizing the therapeutic benefits.

Without appropriate treatment, ADHD can have serious consequences, including repeated failure at school, professional difficulties and relationship problems. Undiagnosed adults are also at increased risk of depression, anxiety and substance abuse disorders. Children, meanwhile, may suffer from low self-esteem and social stigma.

Although it is not possible to prevent ADHD completely, certain measures can reduce the risks or mitigate the effects. A healthy lifestyle during pregnancy, in particular the avoidance of toxic substances such as alcohol and tobacco, is essential. In addition, early diagnosis and appropriate treatment can minimise the long-term consequences of the disorder.

What are the early signs of ADHD in children?
The first signs include difficulty concentrating, a tendency to become excessively agitated and an inability to wait one's turn or follow instructions.

Does ADHD disappear with age?
In some individuals, symptoms diminish with age, but for many, ADHD persists into adulthood.

What medicines are used to treat ADHD?
Stimulant drugs, such as methylphenidate, are commonly used. Non-stimulant alternatives are also available.

Is ADHD more common in boys than in girls?
ADHD is more often diagnosed in boys, but this may reflect differences in the way symptoms manifest themselves.

Can diet influence ADHD?
Although some specific diets have been proposed, there is no solid evidence to support a direct link between diet and ADHD.

How can I help a child with ADHD at school?
Strategies such as regular breaks, a structured environment and individualised support can help a great deal.

Can ADHD be hereditary?
Yes, studies show a strong genetic component in ADHD.