ADHD: Inattention and hyperactivity are the focus of research, but emotional problems may be the missing link

Attention deficit hyperactivity disorder (ADHD) is one of the most common mental health disorders In children, it affects 7.2% of people under the age of 18 worldwide. Many of these children still have ADHD as they enter puberty and adulthood.

ADHD is diagnosed using criteria from a document called the DSM-5, which includes symptoms of inattention, hyperactivity, and impulsivity. But researchers are increasingly finding that the condition also involves problems with self-control, affecting the ability to regulate emotions.

For example, 2.1% of children diagnosed with ADHD also have a mood disorder such as depression, and 27.4% have an anxiety disorder. Many people also explode with verbal and physical aggression.

These previously understudied aspects of the condition are now offering new insights into what is going on in the brains of people with ADHD and hold promise for new and improved treatments. is rising.

If ADHD is not treated effectively, it can have a significant impact on a child’s mental health, well-being, and educational attainment. It can also affect parents, siblings, and even other children in the classroom.

Also read | Double punch of ASD and ADHD

So what are the neural connections between ADHD and emotions? published of natural medicine In collaboration with colleagues at Fudan University in China, we investigated common brain factors called neuropsychopathological factors (NP factors) that underlie multiple mental health disorders, from depression to ADHD. Identified the foundation.

Using a combination of neuroimaging, cognitive and genetic data, many mental health conditions may be linked to a genetically determined unifying problem of ‘synaptic pruning’. I discovered something.

This process usually occurs in childhood and involves building extra synapses (brain structures that help brain cells to transmit electrical or chemical signals) in order to increase brain efficiency and optimize connections between regions. Remove.

This pruning problem may be the root cause, explaining why children with ADHD are often co-morbid with other mental health conditions. Ultimately, it leads to underdevelopment of the prefrontal cortex, which is responsible for the ‘cognitive control’ over our emotions and actions. That means people with ADHD can struggle with their emotions.

Underdevelopment of the prefrontal cortex may also explain why children with ADHD often have cognitive deficits such as problems with executive function (planning, self-monitoring, self-control, working memory, etc.). But so do children with depression and anxiety. So what ultimately is the root of the problem?

one Recent large-scale studies A survey of 11,876 children aged 9 to 12 provides a clue. The University of Cambridge found that cognitive deficits in children with more symptoms of ADHD were specifically related to attentional problems rather than emotional problems.

Children with symptoms of anxiety and depression show these deficits only if they also have attention problems. Therefore, it seems that one possible way for her to support the cognitive development of children with ADHD or mood disorders is to focus on improving attention.

Treatment

Another way to learn more about ADHD is to study the effects of drugs used to treat ADHD. The main drug treatment for ADHD is called methylphenidate or Ritalin.

Methylphenidate works broadly by increasing three chemicals in the brain: dopamine, serotonin, and noradrenaline. Dopamine can improve attention, learning, working memory and motivation, while norepinephrine reduces impulsivity and increases alertness. Serotonin is known to improve symptoms of anxiety and depression.

We know quite a bit about which areas of the brain these drugs target. In fact, the dopamine system affects multiple brain regions.

One study showed that methylphenidate treatment improved attention, which was associated with increased dopamine in the ventral striatum (an area associated with reward and motivation) of the brain. This means that dopamine reward/motivational circuits in the brain are likely important in ADHD.

Another study found that methylphenidate improved working memory, which is known to be influenced by dopamine, and showed increased blood flow to the prefrontal and parietal cortices, areas important for executive function. was shown. This study suggests that frontal-related cognitive control can be improved by methylphenidate.

It also supports our findings that ADHD is associated with delayed development of the prefrontal cortex, making it difficult to exert cognitive control.

Similarly, further studies have shown that methylphenidate greatly improved Emotional symptoms in ADHD adults. However, it is not yet known whether methylphenidate works top-down through the prefrontal cortex to regulate emotion, directly on emotion processing itself, or a combination of both.

That being said, it is now becoming clear that problems with emotional regulation are not just a co-occurring problem, but a core symptom of ADHD. Emotional dysregulation is therefore an important target for treatment.

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Cognitive-behavioral therapy is effective in treating problems with self-control and low mood. Children with ADHD should be offered this in conjunction with medication.

ADHD on the rise

As the number of people diagnosed with ADHD increases worldwide, so too do methylphenidate prescriptions. In fact, in the last 20 years, the prevalence of diagnosed ADHD among children and adolescents aged 4 to 17 in the United States has increased from 6.1% to 10.2%, according to the National Health Interview Survey. .

A UK study estimates ADHD drug use to be: increased by almost 800% From 2000 to 2015.

With the increased use of technology and remote schooling and work, we are more likely than ever to multitask and spread our attention, rather than focusing on one task at a time. Now The prevalence of ADHD is likely to increase further in the future as coping strategies become ineffective and people seek help and eventually receive a diagnosis.

Ironically, some of the solutions may rely on technology such as cognitive training using gaming apps on iPads and mobile phones. For example, Decoder, which has been shown to improve attention span in young adults.

The more we learn about the brain foundations of ADHD, the easier it will be to treat.

Barbara Jacqueline SahakianProfessor of Clinical Neuropsychology, Cambridge University and Christel LangleyPostdoctoral Fellow, Cognitive Neuroscience, Cambridge University

This article is reprinted from conversation Under Creative Commons License.read Original work.