By: Bhavya Appannagaari and Natalie L. Boehm, MBA, RBLP-T
What is ADHD?
ADHD is one of the most common mental health disorders for individuals. The diagnosis is often diagnosed in early childhood and continues into adulthood. ADHD can impact an individual in many ways. Children and adults with ADHD can have trouble paying attention or controlling impulsive behavior; they can also be overactive (Centers for Disease Control and Prevention, 2022).
According to the American Psychiatric Association, ADHD is considered a chronic and debilitating disorder that can impact an individual in many ways. Examples are academic and professional achievements, relationships, and daily life functions. It can lead to poor self-esteem and a lack of social functioning in adolescents. Adults dealing with ADHD may have low levels of self-worth. About 8.4 percent of children and 2.5 percent of adults have ADHD. ADHD is more commonly diagnosed in boys, but it does not factor in to the fact that they have a higher chance of procuring ADHD (American Psychiatric Association, 2022).
DSM-V Criteria for ADHD Diagnosis
According to the Centers for Disease Control and Prevention, the DSM criteria for ADHD shows signs of inattention and/or hyperactivity (impulsivity):
Inattention:
Children up to 16 years of age: must display six or more symptoms for at least six months
17 years of age to adulthood: must display five or more symptoms for at least six months
Symptoms include:
- Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
- Has trouble holding attention to tasks or play activities
- Does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties
- Often has trouble organizing tasks and activities
- Often avoids, dislikes, or is reluctant to do tasks (e.g. homework) that requires mental effort over a long period of time
- Often loses things necessary for tasks and activities (school materials, keys, wallet, cell phone)
- Is easily distracted
- Is often forgetful about daily activities
(Centers for Disease Control and Prevention, 2022)
Hyperactivity/Impulsivity:
Children up to 16 years of age: must display six or more symptoms for a minimum of 6 months
17 years of age to adulthood: must display five or more symptoms for a minimum of 6 months
Symptoms include:
- Often fidgets with or taps hands, feet, or squirms in seat
- Often leaves seat in situations when remaining seated is expected
- Often runs about or climbs in situations when not appropriate
- Often unable to play or take part in leisure activity quietly
- In often “on the go” acting as if “driven by a motor”
- Often talks excessively
- Often blurts out an answer before a question has been completed
- Often has trouble waiting their turn
- Often interrupts or intrudes on others
(Centers for Disease Control and Prevention, 2022)
In addition, the following conditions must be met:
- Has many hyperactive/inattentive symptoms before age 12
- Symptoms present in two or more settings (home/school/work/friends)
- Clear signs that symptoms interfere with daily functions
- Symptoms not due to another disease (schizophrenia or other health disorders)
(Centers for Disease Control and Prevention, 2022)
According to the National Health Service, a general practitioner (physician) will send a patient with a possibility of having ADHD for an assessment. An assessment might be done by a child or adult psychiatrist, a neurologist, or another medical professional who is specialized in diagnosing ADHD. Along with a diagnostic interview, questioning family members about symptoms can assist in making a proper diagnosis. According to CHADD, a diagnostic interview is a dominant part of a comprehensive evaluation. It provides a history of the person being evaluated, with the goal of following DSM-V criteria to reduce error and make a proper diagnosis.
How can ADHD affect someone with epilepsy?
ADHD is most strongly related to a diagnosis for people with epilepsy. Children are at a higher risk of having seizures if they are diagnosed with ADHD. Around fourteen percent of children with ADHD are at an increased risk of being diagnosed with epilepsy (Abramowitz et. al., 2018). The same characteristics associated with epilepsy can increase the chances of developing ADHD. Genetics, brain structure differences, traumatic brain injury, and prenatal exposure to drugs and alcohol increase the chances of a diagnosis.
Children with epilepsy may experience cognitive behavior and emotional difficulties. According to the article, ADHD and Epilepsy Often Co-Occur—Here’s What Experts Know About the Link, the following neurological differences can lead to certain ADHD symptoms:
- Less thalamus volume: a small 2012 study suggested that fewer nerve fibers coming out of the thalamus may lead to inattention symptoms.
- Less grey matter in the frontal lobe: the frontal lobe helps you to make decisions. A small 2016 study linked less grey matter in this area to the inattentive subtype of ADHD.
- Less brain stem volume: if you have a smaller brain stem, you may have a harder time staying alert.
(Swaim and Washington, 2022)
What are the treatment options for ADHD?
For patients with epilepsy and ADHD, medication is one form of treatment. Precautions must be taken due to some anticonvulsant medications can cause symptoms similar to ADHD.
Medications that can exacerbate ADHD symptoms are:
Phenobarbital
Topiramate (Topamax)
Valproic acid
Phenytoin (Phenytek)
Medications that can help improve ADHD symptoms are:
Carbamazepine- can also help enhance attention
Lacosamide (Vimpat)
Lamotrigine (Lamictal)- can also help enhance attention
(Swaim and Washington, 2022)
According to Mayo Clinic, psychostimulants are the most commonly prescribed medication for ADHD. Psychostimulants help to boost and balance neurotransmitters, improve signs and symptoms on inattention and hyperactivity.
Psychostimulants used to control ADHD are:
Amphetamines: dextroamphetamine (Dexedrine), dextroamphetamine-amphetamine (Adderall XR, Mydayis), and lisdexamfetamine (Vyvanse).
Methylphenidates: methylphenidate (Concerta, Ritalin) and dexmethylphenidate (Focalin).
(Mayo Clinic, 2019)
Conclusion
According to the American Psychiatric Association, ADHD is considered a chronic and debilitating disorder that can impact an individual in many ways. Inattention, hyperactivity, and impulsive behavior are common symptoms. People with ADHD are more likely to develop epilepsy. Anticonvulsants and psychostimulants are common medications that people with ADHD and epilepsy take.
Resources:
Abramowitz, A., Hollingsworth, P., Sirven, J., and Shafer, P. (2018). Epilepsy and ADHD. Epilepsy Foundation. Retrieved from: https://www.epilepsy.com/complications-risks/moods-behavior/adhd
American Psychiatric Association (2022). What is ADHD? American Psychiatric Association. Retrieved from: https://www.psychiatry.org/patients-families/adhd/what-is-adhd
Centers for Disease Control and Prevention (2022). Symptoms and Diagnosis of ADHD. Centers for Disease Control and Prevention. Retrieved from: https://www.cdc.gov/ncbddd/adhd/diagnosis.html
Centers for Disease Control and Prevention (2022). What is ADHD? Centers for Disease Control and Prevention. Retrieved from: https://www.cdc.gov/ncbddd/adhd/facts.html
CHADD (2023). Diagnosis of ADHD in Adults. CHADD. Retrieved from: https://chadd.org/for-adults/diagnosis-of-adhd-in-adults/
Mayo Clinic (2019). Attention-deficit/hyperactivity disorder (ADHD) in children. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/diseases-conditions/adhd/diagnosis-treatment/drc-20350895
National Health Services (2021). Diagnosis, Attention deficit hyperactivity disorder. NHS. Retrieved from: https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/diagnosis/
Swaim, E. and Washington, N. (2022). ADHD and Epilepsy Often Co-Occur—Here’s What Experts Know About the Link. Healthline. Retrieved from: https://www.healthline.com/health/adhd/adhd-and-epilepsy
