Attention deficit hyperactivity disorder (ADHD/ADD) - causes, symptoms & pathology

Summary

The script clarifies misconceptions about ADD and ADHD, explaining that they are synonymous, with ADHD encompassing inattention, hyperactivity, and impulsiveness. It details the three subtypes of ADHD as outlined in the DSM-5 and the criteria for diagnosis. The complex etiology involving genetic and environmental factors is discussed, highlighting the role of neurotransmitters like dopamine and norepinephrine. The script also covers treatment approaches, including behavioral psychotherapy and medication, emphasizing the controlled release of dopamine by ADHD medications to improve focus and attention.

Takeaways

• 🔄 ADD and ADHD are actually synonymous terms, with ADD being an outdated term used before 1987.
• 🔍 ADHD encompasses symptoms of inattention, hyperactivity, and impulsiveness, not just an inability to focus.
• 📚 According to the DSM-5, the most recent update in 2013, ADHD is divided into three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined type.
• 🚫 A diagnosis of ADHD requires the presence of at least six out of nine symptoms for at least six months for either subtype.
• 👶 ADHD is considered a neurodevelopmental disorder with symptoms typically emerging between the ages of 6 and 12.
• 🧬 The cause of ADHD is complex and likely involves a combination of genetic and environmental factors.
• 👨‍👧‍👦 A genetic component is suggested by higher likelihood of ADHD in siblings, especially identical twins, though it is not deterministic.
• 🧬 The severity of ADHD symptoms may be influenced by multiple genes affecting neurotransmitter production or regulation.
• 💊 Neurotransmitters like dopamine and norepinephrine are thought to play a role in ADHD, with lower levels potentially contributing to symptoms.
• 💼 Treatment for ADHD can include behavioral psychotherapy, medication, or a combination of both, tailored to the individual's symptoms.
• 👶👩 For children, behavioral therapy often involves structured routines and rewards, with parental and teacher involvement being crucial.
• 💊 Stimulant medications are often the first-line treatment for ADHD, working by increasing neurotransmitter levels to reduce symptoms.

Q & A

What is the relationship between ADD and ADHD?

ADD and ADHD are actually synonymous, meaning they refer to the same condition. ADD was an outdated term used before 1987, which evolved into ADHD to better encompass the range of symptoms experienced by individuals with the disorder.

How are ADHD symptoms categorized according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)?

The DSM-5 categorizes ADHD into three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and a combined subtype that includes symptoms of both.

What are some examples of symptoms for the inattentive subtype of ADHD?

Symptoms of the inattentive subtype may include making careless mistakes, not listening, or being easily distracted.

What are some examples of symptoms for the hyperactive-impulsive subtype of ADHD?

Symptoms of the hyperactive-impulsive subtype may include fidgeting, squirming, or frequently getting up from a chair.

How many symptoms are required for a diagnosis of ADHD, and for how long must these symptoms be present?

A diagnosis of ADHD requires that an individual has at least six of the nine symptoms for either subtype, and these symptoms must be present for at least six months.

At what age range do symptoms of ADHD typically start, and what is the consideration regarding the behavior's appropriateness for age?

Symptoms of ADHD typically start between the ages of 6 and 12, and the behavior must not be age-appropriate for a diagnosis to be made.

What factors are believed to contribute to the development of ADHD?

ADHD is thought to be influenced by a combination of environmental and genetic factors. Genetic factors are suggested by higher rates of ADHD in siblings, especially identical twins, but environmental factors also play a role.

How might genetic factors influence the severity of ADHD symptoms?

Genetic factors likely influence the production or regulation of the brain's neurotransmitters, which are involved in attention and behavior. It is not one single gene but multiple genes that may determine the severity of symptoms.

Which neurotransmitters are implicated in ADHD, and how might their levels affect the symptoms?

Dopamine and norepinephrine are neurotransmitters implicated in ADHD. Lower levels of these neurotransmitters may contribute to the symptoms of ADHD, as they are involved in reward, risk-taking, impulsivity, attention, and arousal.

What are the common treatment approaches for ADHD, and how do they differ between children and adults?

Treatment for ADHD may involve behavioral psychotherapy, medication, or both. Behavioral psychotherapy often targets children, focusing on time management and organizational skills, while for adults, it may focus on reducing distractions and improving organization. Medication, when prescribed, typically involves stimulants that increase neurotransmitter levels to reduce symptoms.

How do ADHD medications differ from illicit stimulants like methamphetamine in terms of their effect on neurotransmitter release?

ADHD medications cause a slow and controlled release of dopamine, which helps improve focus and attention, whereas illicit stimulants like methamphetamine cause a rapid and large release of dopamine, leading to euphoria and addiction.

Outlines

00:00

🧠 Understanding ADHD: Symptoms and Subtypes

This paragraph clarifies misconceptions about ADD and ADHD, explaining that they are synonymous terms. ADHD is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsiveness. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorizes ADHD into three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined type. A diagnosis requires the presence of six out of nine symptoms for at least six months. The paragraph also touches on the disorder's onset between ages 6 and 12 and the inappropriateness of behavior relative to age. Causes of ADHD are complex, involving a combination of genetic and environmental factors, with a genetic component suggested by higher likelihood in siblings, especially identical twins. The role of neurotransmitters, specifically dopamine and norepinephrine, is discussed, as their levels are thought to contribute to ADHD symptoms.

05:04

💊 ADHD Medication: Slow Release vs. Illicit Stimulants

This paragraph delves into the treatment of ADHD, focusing on medication. It contrasts ADHD medications, which release dopamine slowly and controllably, with illicit stimulants like methamphetamine, which cause a rapid and disruptive surge of dopamine. The slow release of dopamine in ADHD medications is crucial for improving focus and attention in patients without causing euphoria or addiction. The paragraph emphasizes the importance of this controlled release mechanism in the effectiveness and safety of ADHD medications.

Keywords

💡ADD

ADD, which stands for Attention Deficit Disorder, is an outdated term used prior to 1987 to describe a condition characterized by an inability to stay focused. The script clarifies that ADD and ADHD are synonymous, and the term evolved into ADHD to better encompass the range of symptoms experienced by individuals. The term ADD is used in the script to illustrate the historical context and transition to the current understanding of ADHD.

💡ADHD

ADHD, or Attention Deficit Hyperactivity Disorder, is a neurodevelopmental disorder that includes symptoms of inattention, hyperactivity, and impulsiveness. The script explains that ADHD is not just about an inability to focus but also involves restlessness and impulsive behavior. The term ADHD is central to the video's theme, as it is the current term used to describe the condition and its various subtypes.

💡Inattentive subtype

The inattentive subtype of ADHD is characterized by symptoms such as making careless mistakes, not listening, and being easily distracted. The script mentions that individuals with this subtype exhibit behaviors that are indicative of an inability to pay attention, which is a key aspect of the disorder.

💡Hyperactive-impulsive subtype

The hyperactive-impulsive subtype of ADHD is defined by symptoms like fidgeting, squirming, and frequently getting up from a chair. The script uses this term to describe individuals who exhibit excessive activity and impulsive behavior, which are distinguishing features of this subtype.

💡Combined subtype

The combined subtype of ADHD refers to individuals who exhibit symptoms of both inattention and hyperactivity-impulsivity. The script notes that most children with ADHD have this subtype, indicating that they experience a mix of symptoms from both the inattentive and hyperactive-impulsive categories.

💡Neurotransmitters

Neurotransmitters are chemical messengers in the brain that facilitate communication between neurons. The script explains that dopamine and norepinephrine are neurotransmitters implicated in ADHD, with lower levels potentially contributing to the disorder's symptoms. The concept of neurotransmitters is crucial to understanding the biological basis of ADHD.

💡Dopamine

Dopamine is a neurotransmitter associated with reward, risk-taking, and impulsive behavior. The script suggests that dopamine plays a significant role in ADHD, as its release is linked to behaviors that are characteristic of the disorder. The term dopamine is used to illustrate the biochemical processes that may contribute to ADHD symptoms.

💡Norepinephrine

Norepinephrine is another neurotransmitter mentioned in the script, which is involved in attention and arousal. It is suggested that a deficiency in norepinephrine may be linked to the attention difficulties seen in ADHD, highlighting its importance in the disorder's pathology.

💡Genetic factors

Genetic factors refer to the hereditary components that may contribute to the development of ADHD. The script provides evidence of a genetic link by discussing the increased likelihood of ADHD in siblings, particularly identical twins, who share the same DNA. This term is essential in understanding the complex etiology of ADHD.

💡Environmental factors

Environmental factors are non-genetic influences that may play a role in the development of ADHD. The script suggests that both genetic and environmental factors are involved in the disorder, indicating that its causes are multifaceted and not solely genetic.

💡Behavioral psychotherapy

Behavioral psychotherapy is a type of treatment for ADHD that focuses on teaching individuals better time management and organizational skills. The script describes how this therapy is often targeted at children, involving structured routines and rewards for adherence, and is an important part of the treatment approach for ADHD.

💡Stimulants

Stimulants are a class of medications commonly prescribed to treat ADHD. The script explains that these medications work by increasing the levels of neurotransmitters like dopamine between neurons, which helps reduce ADHD symptoms. The term stimulants is used to describe the first-line treatment options for ADHD and their mechanism of action.

Highlights

ADD and ADHD are synonymous and used interchangeably.

ADD was an outdated term that evolved into ADHD in 1987.

ADHD encompasses symptoms of inattention, hyperactivity, and impulsiveness.

ADHD is split into three subtypes: inattentive, hyperactive-impulsive, and combined.

A diagnosis requires six of nine symptoms for at least six months.

Children commonly exhibit symptoms of both subtypes, leading to a combined subtype diagnosis.

ADHD is a neurodevelopmental disorder with symptoms starting between ages 6 and 12.

Behaviors associated with ADHD should not be age-appropriate.

ADHD's causes are complex, involving a combination of environmental and genetic factors.

Genetic predisposition to ADHD is suggested by higher rates in siblings, especially identical twins.

Multiple genes, not a single one, likely influence ADHD's severity and neurotransmitter regulation.

Neurotransmitters dopamine and norepinephrine are implicated in ADHD due to their roles in reward, risk-taking, attention, and arousal.

Lower levels of dopamine and norepinephrine are thought to contribute to ADHD symptoms.

The exact reasons for neurotransmitter imbalances in ADHD are not fully understood.

ADHD treatment often involves behavioral psychotherapy, medication, or a combination.

Behavioral psychotherapy for children focuses on time management and organizational skills.

Involvement of parents and teachers is crucial in behavioral therapy for children with ADHD.

Stimulant medications are first-line treatments for ADHD due to their effect on neurotransmitter levels.

ADHD medications release dopamine slowly, unlike illicit stimulants which cause a rapid release.

The slow dopamine release from ADHD medications helps improve focus and attention in patients.

Transcripts

What most people know—or think they know—about attention deficit disorder, or ADD, is that

it’s used to describe somebody who can’t stay focused…and when they REALLY can’t

focus, they have attention deficit hyperactivity disorder, or ADHD.

This continuum from one to the next isn’t quite how it works, though.

ADD and ADHD are actually synonymous, as in, they’re the same.

ADD’s an outdated term used prior to 1987, after which it evolved into ADHD to encompass

more of the symptoms that people with ADHD often experience, which in addition to being

inattentive, includes both hyperactivity and impulsiveness.

So somebody might be diagnosed with ADHD because they have symptoms related to not being able

to pay attention, but they also might be diagnosed with ADHD if they have symptoms relating to

being overly active and impulsive.

They might also have ADHD if they have symptoms of both.

According to the diagnostic and statistical manual for mental disorders, the fifth edition,

the most recent update being in 2013, ADHD is split into these three subtypes: inattentive,

hyperactive-impulsive, or both.

Inattentive and hyperactive-impulse have a set of nine symptoms.

For example, someone with the inattentive subtype might make careless mistakes, or not

listen, or be easily distracted; and someone with the hyperactivity and impulsive subtype

might fidget, or squirm around, or get up from their chair often.

Now, you might be thinking that everyone fidgets now and then, right?

Well a diagnosis is given when someone has 6 of the 9 symptoms for either subtype for

at least 6 months.

Most commonly though, children have symptoms of both subtypes and therefore have the combined

subtype.

Since ADHD is considered a neurodevelopmental disorder, the symptoms also have to have started

between age 6 and 12, and the behavior can’t be appropriate for their age.

Alright, but what causes someone to be hyperactive, or impulsive, or inattentive?

Well, as you might guess, it’s pretty complicated...and we don’t really know, probably a lot of

different factors, and ultimately they all fall into some combination of environmental

and genetic factors.

One interesting clue to a genetic component of ADHD is looking at families—for example,

a child with a sibling that’s been diagnosed with ADHD is more likely to develop it themselves.

Furthermore, if those siblings are identical twins, meaning they have the same DNA, their

chances of developing ADHD is considerably higher.

Having identical DNA doesn’t mean that the twin is definitely going to develop ADHD,

though, which again, suggests that both genetic factors and environmental factors play a part.

As to a specific gene, it’s probably not one single gene that leads to ADHD, but rather

multiple genes that determines how severe their symptoms are.

These genes likely influence the production or regulation of the brain’s neurotransmitters,

which are signaling molecules in the brain that are released by one neuron, and received

by receptors of another neuron.

This movement from a neurotransmitter from neuron A to neuron B is basically a message

being relayed—it’s like the neurons are talking.

Dopamine’s a specific neurotransmitter that gets released when the brain’s involved

with behaviors like getting a reward, taking a risk, and being impulsive.

Norepinephrine is another neurotransmitter involved in attention and arousal.

It’s thought that lower amounts of these two neurotransmitters floating around contributes

to symptoms of ADHD.

The reason why these neurotransmitters might be down in the first place is still not well

understood, and research remains ongoing.

Treatment for ADHD can be tricky, since symptoms may vary from patient to patient, although

it most often involves either behavioral psychotherapy, medication, or both.

Behavioral psychotherapy is often targeted at children, and focuses on teaching the child

better time management and organizational skills.

For example, having structured routines that they can follow and then giving rewards when

they stick to the routines.

Also, involving both parents and teachers are important, and both behavioral parent

training and behavioral classroom management have been been shown to be helpful for children

with ADHD.

For adults, behavioral psychotherapy might focus on ways of decreasing distractions and

also improving organizational skills.

If medications are prescribed, typically the first-line options are stimulants.

Since it’s thought that low levels of neurotransmitters are involved in ADHD, stimulants are used

because they tend to increase the number of neurotransmitters, like dopamine, between

neurons, therefore reducing symptoms.

Common and well-known ADHD medications are molecules that are chemically similar to illicit

stimulants like methamphetamine, but there are some key differences to keep in mind here.

All of these chemicals help to increase the release of dopamine from neuron A, but the

ADHD medications typically cause a slow release of dopamine, whereas illicit stimulants like

methamphetamine cause a really fast release of dopamine.

In fact, it’s this incredible surge of dopamine that disrupts normal communication between

neurons and produces euphoria, and is the reason that illicit substances like methamphetamine

are highly addictive.

In contrast, the slow and controlled release of dopamine caused by ADHD medications is

key, and helps a lot of patients improve their focus

and attention.