ACKNOWLEDGEMENT

I express my gratitude to those who significantly

contributed to my project on my topic
“THE NEUROLOGICAL BASIS OF ADHD – THE
UNSEEN SIDE”. I thank my Biology teacher, [Link],
for their guidance and support. I also acknowledge
my school teachers, for providing me this
opportunity to speak about my topic. Extended
thanks to my classmates, and for their
encouragement. Finally, I acknowledge my family’s
support especially my parents who helped me with
this project.
 𝖈𝖔𝖓𝖙𝖊𝖓𝖙𝖘
Introduction
Signs and Symptoms
- Types of ADHD
• Predominantly Inattentive (ADHD-PI or ADHD-I)
• Predominantly Hyperactive-Impulsive (ADHD-HI)
• Combined Presentation (ADHD-C)
- Symptoms :
• Characteristics in childhood
• Relationship difficulties
• Hyperfocus
• Mind wandering
Cause
Mechanism
Diagnosis
Management
Summary
Bibliography
 𝖆𝖙𝖙𝖊𝖓𝖙𝖎𝖔𝖓 𝖉𝖊𝖋𝖎𝖈𝖎𝖙 𝖍𝖞𝖕𝖊𝖗𝖆𝖈𝖙𝖎𝖛𝖎𝖙𝖞 𝖉𝖎𝖘𝖔𝖗𝖉𝖊𝖗
{𝖆𝖉𝖍𝖉}

“IT’S NOT A DEFICIT OF ATTENTION, IT’S

ABUNDANCE OF INTEREST”

Attention deficit hyperactivity disorder (ADHD) is a

neurodevelopmental disorder characterized by
symptoms of inattention, hyperactivity, impulsivity,
Impairments resulting from deficits in self-regulation
such as time management, cognitive inhibition, task
initiation, and sustained attention can include poor
professional performance, relationship difficulties,
and numerous health risks collectively predisposing to
a diminished quality of life and a reduction in life
expectancy It is associated with other mental disorders
as well as non-psychiatric disorders, which can cause
additional impairment pervasive, impairing in multiple
contexts. Impairments resulting from deficits in self-
regulation such as time management, cognitive
inhibition, task initiation, and sustained attention can
include poor professional performance, relationship
difficulties, and numerous health risks, collectively
predisposing to a diminished quality of life and a
reduction in life expectancy. It is associated with other
mental disorders as well as non-psychiatric disorders,
which can cause additional impairment. The precise
causes of ADHD are unknown in most individual
cases.[37][38] Meta-analyses have shown that the
disorder is primarily genetic with a heritability rate of
70–80%, where risk factors are highly accumulative.
The environmental risks are not related to social or
familial factors; they exert their effects very early in life,
in the prenatal or early postnatal period. However, in
rare cases, ADHD can be caused by a single event
including traumatic brain injury, exposure to
biohazards during pregnancy, or a major genetic
mutation. As it is a neurodevelopmental disorder, there
is no biologically distinct adult-onset ADHD except for
when ADHD occurs after traumatic brain injury.
 Signs and symptoms

Inattention, hyperactivity (restlessness in adults),

disruptive behavior, and impulsivity are common in
ADHD. Academic difficulties are frequent, as are
problems with relationships. A diagnosis can be hard to
ascertain, as it is hard to distinguish between normal
levels of symptoms and levels that cause significant
impairment in major life activities.

According to the fifth edition of the Diagnostic and

Statistical Manual of Mental Disorders (DSM-5) and
its text revision (DSM-5-TR), symptoms must be
present for six months or more to a degree that is much
greater than others of the same age. This requires at
least six symptoms of either inattention or
hyperactivity/impulsivity for those under 17 and at
least five symptoms for those 17 years or older. The
symptoms must be present in at least two settings
(e.g., social, school, work, or home), and must directly
interfere with or reduce quality of functioning.
Additionally, several symptoms must have been
present before age 12 as per DSM-5 criteria. However,
research indicates the age of onset should not be
interpreted as a prerequisite for diagnosis given
contextual exceptions. There are three types of ADHD
namely :

• TYPES OF ADHD:
Predominantly Inattentive (ADHD-PI or ADHD-I)
Predominantly Hyperactive-Impulsive (ADHD-HI)
Combined Presentation (ADHD-C)

1. Predominantly Inattentive (ADHD-PI or ADHD-I) :

Multiple symptoms of inattention that directly negatively

impact occupational, academic or social functioning.
Symptoms may not be present when engaged in highly
stimulating tasks with frequent rewards. Symptoms are
generally from the following clusters:

• Struggles to maintain focus on tasks that are not highly

stimulating/rewarding or that require continuous effort;
details are often missed, and careless mistakes are
frequent in school and work tasks; tasks are often
abruptly abandoned in favor of another before they are
completed.
 • Easily distracted (including by own thoughts); may not
listen when spoken to; frequently appears to be lost in
thought. Often loses things; is forgetful and disorganized
in daily activities.

2. Predominantly Hyperactive-Impulsive (ADHD-HI) :

Multiple symptoms of hyperactivity/impulsivity that directly

negatively impact occupational, academic or social
functioning. Typically, these tend to be most apparent in
environments with structure or which require self-control.
Symptoms are generally from the following clusters:

• Excessive motor activity; struggles to sit still, often

leaving their seat; prefers to run about; in younger
children, will fidget when attempting to sit still; in
adolescents and adults, a sense of physical
restlessness or discomfort with being quiet and still.

• Talks too much; struggles to quietly engage in activities.

Blurts out answers or comments; struggles to wait their
turn in conversation, games, or activities; will interrupt
or intrude on conversations or games.
 • A lack of forethought or consideration of consequences
when making decisions or taking action, instead
tending to act immediately (e.g., physically dangerous
behaviors including reckless driving; impulsive
decisions).

3. Combined Presentation (ADHD-C) :

Criteria are met for both inattentive and hyperactive-

impulsive ADHD, with neither clearly predominating.

o SYMPTOMS :
• Characteristics in childhood
• Relationship difficulties
• Hyperfocus
• Mind wandering

• Characteristics in childhood :

Difficulties managing anger are more common in children

with ADHD, as are delays in speech, language and motor
development. Poorer handwriting is more common in
children with ADHD. Poor handwriting can be a symptom of
ADHD in itself due to decreased attentiveness. When this is a
pervasive problem, it may also be attributable to dyslexia or
dysgraphia. There is significant overlap in the
symptomatology of ADHD, dyslexia, and dysgraphia. 3 in 10
people diagnosed with dyslexia experience co-occurring
ADHD. Although it causes significant difficulty, many
children with ADHD have an attention span equal to or
greater than that of other children for tasks and subjects they
find interesting.

• Relationship difficulties :

People with ADHD of all ages are more likely to have

problems with social skills, such as social interaction
and forming and maintaining friendships. This is true
for all presentations. About half of children and
adolescents with ADHD experience social rejection by
their peers compared to 10–15% of non-ADHD children
and adolescents. People with attention deficits are
prone to having difficulty processing verbal and
nonverbal language which can negatively affect social
interaction. They may also drift off during
conversations, miss social cues, and have trouble
learning social skills.
- Hyperfocus :

An association between ADHD and hyperfocus, a state

characterized by intense and narrow concentration on
a specific stimulus, object or task for a prolonged
period of time, has been widely reported in the popular
science press and media. The phenomenon generally
occurs when an individual is engaged in activities, they
find highly interesting, or which provide instant
gratification, such as video games or online chatting.
Hyperfocus is not a recognized symptom of ADHD in
diagnostic manuals, but is frequently referred to as a
symptom of ADHD in academic literature and
commonly reported in patients with ADHD in clinical
practice. There is a lack of research into hyperfocus in
ADHD. Studies in 2016, 2019 and 2024 found that
individuals with ADHD diagnoses or self-reported
ADHD symptoms experience hyperfocus more often,
or more acutely. A 2020 study did not find a higher
frequency of hyperfocus in adults with ADHD, although
it reported a positive correlation with self-reported
ADHD traits. The discrepancy with other studies may
reflect varying definitions and conceptions of
hyperfocus. A state of hyperfocus has been
hypothesized as being beneficial, allowing individuals
to focus on tasks for much longer than is typical.
Conversely, it can be difficult to disengage from and
shift attention to other stimuli or tasks, leading to
excessively prolonged attention. This can lead to
neglect of other activities or personal needs, such as
eating or using the toilet. It is related to risks such as
internet addiction and to some types of offending
behavior. Recent research has linked hyperfocus to the
psychological concepts of flow, an enjoyable
experience of deep engagement in an activity, and
perseveration, difficulty disengaging or switching from
an activity.

• Mind wandering :

Mind wandering is a situation in which attention drifts

from the main task to personal inner thoughts. The
connection between mind wandering and ADHD has
become a focus of growing research interest. The
European Consensus Statement on diagnosis and
treatment of adult ADHD identified mind wandering as
a common characteristic of adults with ADHD and a
strong predictor of the condition, noting that it may be
even more predictive than the classic symptoms of
inattention or hyperactivity. Studies have consistently
found that individuals with ADHD symptoms report
significantly more mind wandering than those without
ADHD symptoms. Research further indicates that
background sounds including music can reduce mind
wandering in individuals with elevated ADHD
symptoms, suggesting environmental sound as a
potential non-pharmacological support strategy.
Studies also show that the relationship between ADHD
symptoms and mind wandering is detectable as early
as kindergarten age, where elevated mind wandering
predicts weaker academic performance in arithmetic
and phonological tasks.

CAUSE

ADHD arises from atypical brain development

especially in the prefrontal executive networks that
can arise either from genetic factors (different gene
variants and mutations for building and regulating
such networks) or from acquired disruptions to the
development of these networks and regions involved
in executive functioning and self-regulation. Their
reduced size, functional connectivity, and activation
contribute to the pathophysiology of ADHD, as well as
imbalances in the noradrenergic and dopaminergic
systems that mediate these brain regions.

Genetic factors play an important role; ADHD has a

heritability rate of 70–80%. The remaining 20–30% of
variance is mediated by de-novo mutations and non-
shared environmental factors that provide for or
produce brain injuries; there is no significant
contribution of the rearing family and social
environment, very rarely, ADHD can also be the result
of abnormalities in the chromosomes.

MECHANISM
Current models suggest that ADHD is linked to
impairments in the brain's dopamine and
norepinephrine neurotransmitter systems. These
neurotransmitters regulate important cognitive
functions. Their pathways project to the prefrontal
cortex and striatum, which control executive function,
motivation, reward perception, and motor function.
When these pathways are impaired, they contribute to
symptoms such as inattention, impulsivity, and
hyperactivity. Researchers have also proposed larger
models involving additional brain pathways.
• Dopamine - a critical chemical messenger and
neurotransmitter produced in the brain that
regulates movement, memory, pleasurable reward,
behavior, and motivation. Often called the "feel-
good" chemical, it helps control the brain's reward
system and reinforces satisfying or addictive actions.

• Norepinephrine – It’s also called as Noradrenaline.

A natural chemical that acts as both a stress
hormone and a brain messenger. It helps run your
body's fight-or-flight response, boosts your attention
and focus, and raises your blood pressure in
emergency medical situations.

• Brain structure :

Children with ADHD often have slightly smaller

volumes in certain brain regions, especially the
prefrontal cortex, which is responsible for attention,
decision-making, and self-control. Other areas such as
the caudate, amygdala, hippocampus, and putamen
are also smaller than average. Brain scans have shown
differences in white matter and stronger-than-normal
connections between some brain regions, which are
linked to symptoms like inattention and hyperactivity.
These structural and functional differences help
explain the neurological basis of ADHD.

DIAGNOSIS

ADHD is diagnosed by an assessment of a person's

behavioral and mental development, including ruling
out the effects of drugs, medications, and other
medical or psychiatric problems as explanations for
the symptoms. Childhood and adolescent ADHD
diagnosis often takes into account feedback from
parents and teachers with most diagnoses begun after
a teacher raises concerns. While many tools exist to
aid in the diagnosis of ADHD, their validity varies in
different populations, and a reliable and valid
diagnosis requires confirmation by a clinician while
supplemented by standardized rating scales and input
from multiple informants across various settings. They
attest that the disorder is considered valid because:

1) well-trained professionals agree on its presence or

absence using well-defined criteria.

2) the diagnosis is useful for predicting;

(a) additional problems the patient may have
(e.g., difficulties learning in school).
(b) future patient outcomes.
(c) response to treatment (e.g., medications
and psychological treatments).
(d) features that indicate a consistent set of
causes for the disorder (e.g., findings from
genetics or brain imaging).
- IN ADULTS :

The DSM provides differential diagnoses – potential alternate

explanations for specific symptoms. Assessment and
investigation of clinical history determines which is the most
appropriate diagnosis. The DSM-5 suggests oppositional
defiant disorder, intermittent explosive disorder, and other
disorders such as stereotypic movement disorder and
Tourette syndrome, in addition to specific learning disorder,
intellectual disability, autism, reactive attachment disorder,
anxiety disorders, depressive disorders, bipolar disorder,
disruptive mood dysregulation disorder, substance use
disorder, personality disorders, psychotic disorders,
medication-induced symptoms, and neurocognitive
disorders. Many but not all of these are also common
comorbidities of ADHD.

• Depressive disorder :
Feelings of hopelessness, low self-esteem, or unhappiness.
loss of interest in hobbies or regular activities. Fatigue. Sleep
problems. Difficulty maintaining attention. Change in
appetite. Irritability or hostility. Low tolerance for stress.
Unexplained pain.
 • Anxiety disorder :
Persistent feeling of anxiety. Irritability. Occasional feelings
of panic or fear. Hypervigilance. Inability to pay attention. Tire
easily. Low tolerance for stress. Difficulty maintaining
attention.

- In Children :
Primary sleep disorders may affect attention and behavior
and the symptoms of ADHD may affect sleep. It is thus
recommended that children with ADHD be regularly
assessed for sleep problems. Sleepiness in children may
result in symptoms ranging from the classic ones of yawning
and rubbing the eyes, to disinhibition and inattention. For
example :
Children may feel distractable and agitated when asked to
engage in tasks that require the impaired skill (e.g., reading,
math), but not in other situations.
 MANAGEMENT

The management of ADHD typically involves;

1. Cognitive Behavioral Therapy (CBT) :

CBT is less effective than medication when used alone.
It is most beneficial when combined with medication.
It helps manage problems that remain even after
medication has improved core ADHD symptoms.

2. Medication :
Common medications include; Stimulants
Atomoxetine, Alpha-2 adrenergic receptor agonists,
Antidepressants (in some cases). Medications are the
most effective treatment for ADHD. They significantly
improve long-term outcomes. They improve attention,
persistence, and task performance. Benefits disappear
if medication is stopped.
 𝕾𝖚𝖒𝖒𝖆𝖗𝖞
• Attention Deficit Hyperactivity Disorder (ADHD) is a
neurodevelopmental disorder that affects attention,
impulse control, self-regulation, and behavior. It is
mainly influenced by genetic factors and differences in
brain development, particularly in the prefrontal cortex
and the neurotransmitters dopamine and
norepinephrine, which control attention, motivation,
and executive functioning.
• ADHD has three types: Predominantly Inattentive,
Predominantly Hyperactive-Impulsive, and Combined
Presentation. Common symptoms include inattention,
hyperactivity, impulsivity, forgetfulness, hyperfocus,
mind wandering, and difficulties in academics and
social relationships.
• Diagnosis involves a thorough clinical assessment of
symptoms across different settings while ruling out
other conditions. Although ADHD has no permanent
cure, it can be effectively managed through
medication, Cognitive Behavioral Therapy (CBT), and
behavioral support. With early diagnosis, proper
treatment, and awareness, individuals with ADHD can
manage their symptoms and lead healthy, productive
lives.
𝕭𝖎𝖇𝖑𝖎𝖔𝖌𝖗𝖆𝖕𝖍𝖞

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