ADHD Treatment; Biology; Self-Acceptance; Interviews; OCD and ADHD
- Arthur
- 16 июл.
- 36 мин. чтения
Обновлено: 23 июл.
Video
Same stuff, but with all the references and lacks the interview with Dr. Mohamed Al Mongi (psychiatrist).
Article Structure
Foreword
In this article I am going to tell you what ADHD is, explain the biology behind it and tell you about various possible treatment and management options. I am also going to tell you a bit of my story and experience with ADHD.
Before I start, I want to state that I do not intend to diminish or deny the necessity of your medication or appointments with certified medical practitioners, for I am not one.
While writing this article, I used and quoted various articles. My goal was not to write a huge essay with unique text, but provide readers with scientifically backed up and well referenced information. Trying to reinvent one thousand wheels would have been absurd.
External material was referenced in a manner that provides a reader with maximum convenience : for instance, “ADHD Biology” section is referenced separately; making a strict scientific referent list at the end of the entire article would have resulted in inconvenience.
The article follows a specific narrative structure, and you can always navigate through the links in the table of contents above.
Introduction
ADHD, or attention-deficit/hyperactivity disorder, is a developmental disorder associated with an ongoing pattern of inattention and/or hyperactivity and impulsivity. ADHD can severely interfere with an individual’s daily life and relationships. ADHD usually begins in childhood and can continue into the teen years and adulthood, although sometimes ADHD can occur in the adulthood.
Some people with ADHD do not know they have it. These people may have difficulties staying organised, sticking to a job or remembering keeping appointments. They possibly struggle with mundane tasks, be it their job or daily routine. These people may have a troublesome history with school, work and relationships. Adults with ADHD might seem restless and may attempt doing several tasks at once — and a great deal of them may be left abandoned. They sometimes prefer fast steps to get quick results, rather than walking a journey to reap greater rewards.
A person might not be diagnosed with ADHD until he’s adult, because teachers or family did not recognise the condition at an earlier age; or he managed fairly well until he got acquainted with the demands of adulthood, for example, at work or college.
It is never too late to seek a diagnosis and treatment. Effective treatment can be a life saver !
ADHD or attention-deficit/hyperactivity disorder. Or is it attention deficit disorder (ADD) ? What is the difference, you might ask.
In 1994, doctors classified all attention-deficit disorder forms to be called "attention-deficit/hyperactivity disorder," or ADHD, even if the person is not showing signs of hyperactivity. Now it is called ADHD, inattentive type, or ADHD, hyperactive/impulsive type, or ADHD, combined type.
People with ADHD experience a certain pattern of symptoms, depending on their ADHD type :
· Inattention : disorganisation, problems staying focused, constant daydreaming, not paying attention when spoken to
· Impulsivity : instantaneous decisions without thinking about the consequences. Acting fast to get an immediate result. Interrupting people
· Hyperactivity : squirming, fidgeting, tapping, talking, and constant movement, even when not appropriate
Some people with ADHD mostly have symptoms of inattention. Others mainly have hyperactivity-impulsivity symptoms. Some people have both symptomatic vectors.
People with ADHD, inattentive type, may find challenging to :
· Pay close attention to details, follow instructions
· Sustain attention while executing lengthy tasks
· Listen closely when spoken to
· Organise tasks and activities, manage time
And easy to :
· Make careless mistakes at work or during other activities
· Lose personal belongings
· Be easily distracted by irrelevant thoughts or stimuli
· Be forgetful in daily life
Signs of hyperactivity and impulsivity for people with ADHD, hyperactive/impulsive type, may include :
· Extreme restlessness, difficulty sitting still for a long time
· Fidgeting with or tapping hands or feet, squirming
· Being unable to quietly execute leisure activities
· Excessive talking
· Answering questions before they are asked completely
· Having difficulty waiting one’s turn, such as when waiting in line
· Interrupting others
· Other concomitant mental disorders, including anxiety, mood and substance use disorders
Inattentive ADHD
Inattentive ADHD (formerly ADD) is a subtype of ADHD that often evinces as limited attention span, distractibility, forgetfulness, procrastination. People with inattentive ADHD are prone to making careless mistakes due to lack of stable focus; they have a hard time following detailed instructions, organising tasks and activities. They are easily distracted by external stimuli, and sometimes lose their belongings. They might leave projects incomplete and appear not to be listening when you talk to them. These are all symptoms of Inattentive-Type ADHD; they are not personal defects.
A student with inattentive ADHD may look out the window, leaving his work unfinished. This daydreaming behaviour is overlooked or mischaracterised as laziness or apathy. According to the National Institute of Mental Health, inattentive ADHD symptoms are far less likely recognised by parents, teachers and medical practitioners, as a result, people with ADHD rarely get the treatment they need. This leads to academic frustration, apathy and shame that can last a lifetime.
A child with inattentive ADHD may rush through a quiz, missing questions, even when he knows the answer; or he might skip whole sections in haste. As an adult, he may fail to carefully proofread a document or email at work, drawing unwanted attention and feeling of embarrassment.
If you try hard to slow down and pay attention, trying to live ‘in the moment’, but find it uncomfortable and even painful, then it’s a big sign you’ve got inattentive ADHD.
Incomplete and half-done projects and assignments are hallmark signs of attention problems in students. Adults with inattentive ADHD can’t stand boring work meetings — much more than their colleagues. They need to be chewing gum, sipping coffee or even standing during meetings in order to sustain attention. If you are consistently frustrated by your inability to maintain stable focus, while reading long documents, listening to people during meetings or doing lengthy projects, this could be a sign you have inattentive ADHD.
Students with inattentive ADHD typically may get around half the instructions given to them — if not less. Their notebooks are filled with more doodles than notes, and they might need to record and relisten lectures several times in order to absorb all the information.
While not studying, people with inattentive ADHD tend to have certain troubles socialising : constantly forgetting faces and names; zoning out of conversations, while seeming distant and apathetic. If you’re consistently being asked something like “Were you not listening ?”, then it might just be another sign you have inattentive ADHD.
For children and adults alike, inattentive ADHD can manifest itself as various projects lying around in states of completion. If you love to plan and start projects, but get distracted and leave a trail of unfinished business, then you might have inattentive ADHD.
Do you keep losing your personal belongings — your keys, your smartphone, etc. ? Does your home look topsy-turvy on a regular basis ? These are signs of inattentive ADHD as well.
Misplacing things like smartphone in the refrigerator or a roast beef in the gym bag (hey, everything’s possible with us, ADHD-ers, innit ?) also makes just another sign of inattentive ADHD.
Please note, that food misplacing, such as pineapple pizza or pickles with chocolate are not signs of ADHD, that’s simply gastronomical perversity 😉
Hyperactive-Impulsive ADHD
Fidgeting or continuously tapping fingers on a table, as well as leg bouncing while seated can denote a hyperactive ADHD brain. People with ADHD struggle to sit still, as their brain is usually overstimulated, trying to find a way to release energy. They tend to feel restless, constantly urged to move.
When people with ADHD cannot release excess energy, they might struggle to relax. Even though being idle and not doing anything, their hyperactive brain might pick up ideas and overthink a lot.
Impulsive behaviour is another sign for Hyperactive-Impulsive ADHD diagnosis. Patient’s self-control can sometimes affect others, as they may miss social cues. This often disrupts conversations. This lack of impulse control can also evince in excessive talking without realising it might not be appropriate. Another manifestation of hyperactive-impulsive ADHD would be the tendency to overshare thoughts, disclose personal information when not needed, or chat with anyone without being asked.
Patients’ impulsive ADHD urges them to speak without thinking first; they might as well not know when to stop talking, too. Such difficulty in controlling these behaviours may cause them to conflict within society, make other people feel disregarded and disrespected. Sometimes, they miss the opportunity to be mindful of their thoughts and words, and how they might affect people around them.
When people think about attention deficit hyperactivity disorder (ADHD), they may feel that someone diagnosed with it is constantly lively and enthusiastic, never running out of “fuel”. However, this is a misconception.
Because of patients’ difficulty relaxing and staying still, they might become tired or exhausted. Many people with predominantly hyperactive-impulsive presentations may seem to be the most energetic, however, when they need to rest, their hyperactive brain still functions, even during sleep, significantly affecting their energy levels.
Another impulsive behaviour that might make people feel disregarded is when people with ADHD don't let other people finish what they are saying, sometimes blurting out the answer to what they are going to say. This can be frustrating for everyone.
As a child, patient can be disrupting the entire class, blurting out answers when he is not asked; as an adult, the person with ADHD can break the natural flow of a conversation or interrupt a speech during a work meeting.
Asides from impulsivity, the other reason for doing so could be forgetfulness; the person simply wants to say something, before he forgets it.
When someone has hyperactive-impulsive ADHD symptoms, risky behaviour often take place. Risky behaviours due to hyperactivity and impulsivity could manifest as reckless driving, uncontrollably spending money or interrupting people during a conversation (possibly the most common symptom).
ADHD Biology
ADHD brain is not wired the same way as a brain without ADHD. Science suggests that specific differences in the brain’s structure, function and chemistry may be a cause of ADHD.
Scientists found out that various medical conditions are linked to lower levels of chemical messengers in the brain, known as neurotransmitters. Such disorders include anxiety, depression, Alzheimer’s disease, mood disorders and ADHD. [1] [2]
One of the most drastic differences between an ADHD brain and a normal brain is a level of norepinephrine. Norepinephrine is created from dopamine. Since the two are related, it is believed that lower levels of dopamine and norepinephrine are both linked to ADHD. [3]
Imbalance in transmission of dopamine in the brain might be associated with ADHD symptoms, including inattention and impulsivity. This disruption may also interfere with dopamine reward pathway, altering the perception of reward and pleasure. [4]
Structure of brain with ADHD can also differ from a non-ADHD brain in certain areas, including the following:
· Frontal cortex : regulates behaviour, emotions and attention. [5]
· Limbic regions : influences emotions and motivation. ADHD-related changes to this area can contribute to hyperactivity, inattention and worse decision-making. [6]
· Basal ganglia : responsible for motor learning (learning a skill). It also helps regulate behaviour, emotions and ability to plan, focus and multi-task — all of which are affected by ADHD. [7]
Another drastic deviation involves default mode network (DMN) of the brain. DMN activates when one’s daydreaming or is not focused on a task or activity.
In ADHD, DMN is more often activated. As a result, one might feel that his focus is constantly being shifted from his current task towards unrelated thoughts. [8]
Thus, staying focused on tedious or repetitive tasks can be troublesome.
A brain with ADHD differs from a non-ADHD one in many ways — size, activity levels of certain regions, chemical signals traveling throughout the brain. Because of these differences, one might find it challenging to organise, plan, focus and manage his emotions.
Let’s dive deeper into what structure, network and chemistry of brain with ADHD look like.
Human brain is divided into different sections — lobes, one of which is the frontal lobe. It controls key functions related to :
· Planning and organisation
· Focus and attention
· Self-monitoring and self-control
· Memory
· Communication
· Problem solving
· Impulse control
· Language
· Social behaviour
· Motivation
· Judgment
Frontal lobe is the largest part of the brain affected by ADHD. This part of the brain may mature at a slower pace or show disrupted activity and connectivity in people with ADHD. [5]
That’s why staying focused, planning and controlling impulses can be challenging for ADHDers.
Groups of nerve cells — neurons — form networks in human brain. These networks are responsible for relaying signals throughout the brain via chemical messengers.
In brain with ADHD, imbalances in function and structure of these networks may cause the brain to transmit messages less effectively.
Scientists found deficits in neural networks linked to attention and executive function in people with ADHD. This may affect one’s ability to organise, prioritise, plan, focus, remember instructions and work towards goals. [9]
Additionally, ADHD may alter network connections between prefrontal cortex (section of the frontal lobe) and other areas of the brain. Scientists believe this is associated with poor planning, distractibility, impulsivity and forgetfulness in ADHD. [9]
Other deficits in networks of the frontal and parietal brain lobes can affect patient’s attention, motivation and ability to control his responses and predict difficulty of a task. It may also change how he makes decisions based on perceived rewards. [9]
Norepinephrine has a significant function in the prefrontal cortex, and ADHD may disrupt its transmission in the brain.
This could make it harder to retain information in order to complete tasks. It might as well impair patient’s inhibitory control, which is how well one can suppress distractions, urges, or behaviours that interfere with his goals. [3]
Meanwhile, dopamine helps to regulate one’s emotions and is linked to feelings of pleasure and reward.
In ADHD, levels of dopamine in the brain might be lower. This makes it more difficult to maintain motivation, especially when the rewards seem too little or not immediate. ADHD brains tend to favour short-term, smaller rewards over long-term, larger ones. [4]
References :
[1] Liu, Y., Zhao, J., & Guo, W. (2018). Emotional Roles of Mono-Aminergic Neurotransmitters in Major Depressive Disorder and Anxiety Disorders. Frontiers in Psychology, 9. https://doi.org/10.3389/fpsyg.2018.02201
[2] Ulke, C., Rullmann, M., Huang, J., Luthardt, J., Becker, G. A., Patt, M., Meyer, P. M., Tiepolt, S., Hesse, S., Sabri, O., & Strauß, M. (2019). Adult attention-deficit/hyperactivity disorder is associated with reduced norepinephrine transporter availability in right attention networks: a (S, S)-O-[11C]methylreboxetine positron emission tomography study. Translational psychiatry, 9(1), 301. https://doi.org/10.1038/s41398-019-0619-y
[3] del Campo, N., Chamberlain, S. R., Sahakian, B. J., & Robbins, T. W. (2011). The Roles of Dopamine and Noradrenaline in the Pathophysiology and Treatment of Attention-Deficit/Hyperactivity Disorder. Biological Psychiatry, 69(12), e145–e157. https://doi.org/10.1016/j.biopsych.2011.02.036
[4] Volkow, N. D., Wang, G. J., Kollins, S. H., Wigal, T. L., Newcorn, J. H., Telang, F., Fowler, J. S., Zhu, W., Logan, J., Ma, Y., Pradhan, K., Wong, C., & Swanson, J. M. (2009). Evaluating dopamine reward pathway in ADHD: clinical implications. JAMA, 302(10), 1084–1091. https://doi.org/10.1001/jama.2009.1308
[5] Gehricke, J. G., Kruggel, F., Thampipop, T., Alejo, S. D., Tatos, E., Fallon, J., & Muftuler, L. T. (2017). The brain anatomy of attention-deficit/hyperactivity disorder in young adults – a magnetic resonance imaging study. PloS one, 12(4), e0175433. https://doi.org/10.1371/journal.pone.0175433
[6] Plessen, K. J., Bansal, R., Zhu, H., Whiteman, R., Amat, J., Quackenbush, G. A., Martin, L., Durkin, K., Blair, C., Royal, J., Hugdahl, K., & Peterson, B. S. (2006). Hippocampus and amygdala morphology in attention-deficit/hyperactivity disorder. Archives of general psychiatry, 63(7), 795–807. https://doi.org/10.1001/archpsyc.63.7.795
[7] Lanciego, J. L., Luquin, N., & Obeso, J. A. (2012). Functional neuroanatomy of the basal ganglia. Cold Spring Harbor perspectives in medicine, 2(12), a009621. https://doi.org/10.1101/cshperspect.a009621
[8] Rubia K. (2018). Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation. Frontiers in human neuroscience, 12, 100. https://doi.org/10.3389/fnhum.2018.00100
[9] De La Fuente, A., Xia, S., Branch, C., & Li, X. (2013). A review of attention-deficit/hyperactivity disorder from the perspective of brain networks. Frontiers in Human Neuroscience, 7. https://doi.org/10.3389/fnhum.2013.00192
Causes
Scientists are studying causes and risk factors of ADHD; causes and risk factors are currently unknown, but research shows that genetics play an important role.
“In addition to genetics, scientists are studying other possible causes and risk factors including:
· Brain injury
· Exposure to environmental risks (e.g., lead) during pregnancy or at a young age
· Alcohol and tobacco use during pregnancy
· Premature delivery
· Low birth weight”
Source : CDC
Treatment
While ADHD is considered uncurable, symptoms can be managed long-term. The best treatment strategies for ADHD show to be multi-approached ones — combinations of several different, complementary methods that work together to reduce symptoms. For one person, this may include medication, nutrition, exercise and behavioural therapy. For somebody else, it might mean taking certain supplements and vitamins, practicing mindfulness and spending time outdoors in nature.
Adult and child patients are increasingly pairing stimulant medication with digital therapies like EndeavorRx, which is available by prescription for patients of age 8 to 12; or pinpointed apps like EndeavorOTC, a new mobile video game, designed to improve focus in adults with ADHD.
Medication
For children age of 6+ and adults, medication may be crucial. Finding the right drug typically involves some trial and error, but can lead to a significant reduction in symptoms.
Two main types of medication used to treat ADHD are stimulants and non-stimulants.
Central nervous system (CNS) stimulants, like Ritalin (methylphenidate) or Adderall (amphetamine salts), are the most prescribed ADHD medications. These ADHD medications work by increasing the amount of dopamine and norepinephrine in the brain, which help with focus. There are three categories of stimulant medications:
· Short-acting (taken a few times a day)
· Intermediate-acting (taken less often)
· Long-acting (taken once a day)
If stimulants’ side effects are problematic, or they are simply not effective, your doctor may suggest trying non-stimulant medication, like Strattera (Atomoxetine) or Intuniv (Guanfacine).
Non-stimulant ADHD medications are considered second or third-line treatments, because benefit and response rates are significantly lower — stimulant medications are more effective at relieving symptoms for a larger fraction of people.
ADHD medications can have many benefits, as well as side effects. The decision to manage ADHD symptoms with medication can be a difficult one.
Have a look at this medication list of ADDitude portal.
Cognitive Behavioural Therapy (CBT)
According to the Centers for Disease Control and Prevention (CDC), behavioural therapy and cognitive behavioural therapy are helpful in reducing symptoms in children with ADHD. And according to American Academy of Pediatrics, behavioural therapy should be the first step in treating ADHD in young children. Although, according to the Child Mind Institute, there is less evidence of effectiveness of Cognitive behavioural therapy (CBT) for teenagers than there is for kids.
There are various forms of behaviour therapy, but here I’ll focus on Cognitive behavioural therapy and Dialectical Behaviour Therapy (DBT). Cognitive behavioural therapy (CBT) is essentially brain training. It is a goal-oriented variety of psychotherapy that aims to change negative thinking patterns and reformulate the way a patient feels about himself and his symptoms.
CBT does not treat core symptoms of ADHD, such as inattention, hyperactivity, impulsivity. It rather helps to reduce life impairments, experienced by people with ADHD, such as procrastination and poor time management. There’s no evidence CBT can replace drug therapy for ADHD, but research suggests it helps adults with ADHD more than other therapy forms do.
A 2010 study by Boston’s Massachusetts General Hospital found that a combination of drug therapy and CBT was more effective at controlling ADHD symptoms than the drug therapy alone.
“An effective CBT program will help adults with ADHD correct the following distorted thought processes and more:
· All-or-nothing thinking — viewing everything as entirely good or entirely bad: If you don’t do something perfectly, you’ve failed.
· Overgeneralization — seeing a single negative event as part of a pattern: For example, you always forget to pay your bills.
· Mind reading — thinking you know what people think about you or something you’ve done — and it’s bad.
· Fortune telling — forecasting that things will turn out badly.
· Magnification and minimization — exaggerating the significance of minor problems while trivializing your accomplishments.
· “Should” statements — focusing on how things should be, leading to severe self-criticism as well as feelings of resentment toward others.
· Comparative thinking — measuring yourself against others and feeling inferior, even though the comparison may be unrealistic.” Source : ADDitude
Dialectical Behaviour Therapy (DBT)
Dialectical Behavioural Therapy (DBT), like CBT, focuses on social and emotional challenges, associated with ADHD and other neuro-psychological disorders. Founded by Marsha Linehan, Ph.D., ABPP, a professor of psychology at the University of Washington and founder of The Linehan Institute, DBT was initially designed to treat harmful behaviour of patients diagnosed with borderline personality disorder (BPD).
It is now one of the most successful treatment options for improving emotional regulation. DBT is taught in a series of skill-based modules in weekly group sessions — each focused on a particular skill. Individual therapists provide additional support to personalise the use of these skills in life situations.
ADHD Coaching
“ADHD coaches help children, teens, and adults with ADHD organize and take charge of their lives. More specifically, coaches can help their clients achieve emotional/intellectual growth, strong social skills, effective learning strategies, compelling career and business exploration, and thoughtful financial planning.
A professionally trained ADHD coach can realistically assist his or her ADHD clients in building skills like:
· Time, task, and space management
· Motivation and follow-through
· Developing systems for success
· Healthy communications and relationships
· Strategic planning and perspective
· Making conscious & wise choices
· A simplified and more orderly life
· Achieving a balanced, healthy lifestyle
One of the best ways to find an ADHD coach is through the ADHD Coaches Organization (ACO). This worldwide professional membership organization offers resources for coaches and those who seek them alike.” Source : ADDitude
Neurofeedback
Neurofeedback utilises brain exercises to decrease impulsivity and increase attention in ADHD patients. Neurofeedback trains the brain to emit brain-wave patterns associated with focus, rather than those associated with day-dreaming, helping to rein ADHD symptoms like impulsivity, distractibility and acting out.
Patients wear an electrode-lined cap, while performing a cognitive task, such as reading aloud. A computer then reads brain activity and maps areas of the brain, where there is too much or too little brain-wave activity – which are, theoretically, sources of the patient’s ADHD symptoms. This digital map allows a comparison between the patient’s brain activity with other brain-wave patterns in databases — which helps fine-tuning a treatment plan by indicating sites for application of electrodes.
Patients wear the same headgear while sitting in front of a video screen during treatment. Their goal is to move characters in a video game (goals differ according to the protocol doctors utilise), while emitting short pulses of sustained brain-wave activity in those areas of the brain thought to be under-aroused. Software monitors and records brain activity. Loss of focus will cause the game to stop; the game only goes on when the patient exercises the area of the brain that is focus-deficient.
Neurofeedback is criticised — there are some reasonable points to acknowledge. Unlike medicine, neurofeedback therapy was not rigorously tested in large, double-blind studies. Some experts say that from the studies it isn’t clear whether improvements in children are due to the therapy or to one-on-one time with a therapist. Another objection is, while neurofeedback might increase attention in some patients, it doesn’t always improve other issues, associated with ADHD.
Some experts say that while neurofeedback has potential, it should be only used together with medicine.
“One promising aspect of neurofeedback is that its benefits seem to remain after the treatment is ended. Vincent Monastra, Ph.D., founder of the FPI Attention Disorders Clinic in Endicott, New York, and author of Parenting Children with ADHD: 10 Lessons That Medicine Cannot Teach, conducted a year-long, uncontrolled study with 100 children who were taking medication, half of whom also received neurofeedback.
Monastra’s results indicate that “patients who did not receive the therapy lost most of the positive effects of treatment one week after they were taken off medication.” Those who combined medication with neurofeedback, he says, maintained their ability to control attention. In fact, says Monastra, who is a practitioner of neurofeedback and other therapies at his clinic, “after the year of neurofeedback therapy, some patients were able to reduce medication dosage by about 50 percent.” Source : ADDitude
The downside of neurofeedback though is its price, which approximately ranges from $ 2,000 to $ 5,000 for a course of treatment.
Other
Various options of alternative therapy exist, such as play therapy, music therapy, art therapy or even equine therapy. There is also limited evidence yoga might help as well.
If you or your kid are suffering from ADHD, some of it might be worth a try; after all, combined therapy has proven to be more effective than a solo approach.
Placebo Treatments
Along with various treatment options that might ease up patients’ ADHD symptoms, there are also remedies that do not work, despite some people might recommend it. I mean, they could work — no more than would a placebo.
Feingold Diet would be an example. Years ago, Dr. Ben Feingold, an allergist, created a popular diet, designed to treat hyperactivity by means of eliminating certain food additives out of the diet.
Feingold Diet excludes artificial colourings, flavourings and preservatives in order to, allegedly, decrease hyperactivity. While most scientific studies have refuted Feingold's theory, some parents who have tried it say they noticed an improvement in their child's behaviour.
Although some experts do not think it is the dietary shift that makes a difference. A popular theory is that a child's behaviour improves because the parents treat their child differently when they’re following a special diet.
Speaking of dietary supplements, there is no proof that supplements ginkgo biloba, St. John’s wort or pycnogenol treat ADHD symptoms.
OCD and ADHD
Both obsessive compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD) are considered pretty common and serious neuropsychiatric disorders. Some of the symptoms associated with attention and concentration might appear astonishingly similar, especially in children and adolescents. OCD and ADHD are, however, very different in terms of brain activity and clinical picture. ADHD is an externalising disorder, which means it affects how people outwardly relate to their environment. Individuals with ADHD might exhibit inattention, lack of impulse control and risky behaviour. Whereas OCD is characterised as an internalising disorder, meaning individuals with OCD respond to anxiety producing environments by turning inward. OCD patients exhibit frequent obsessive and/or compulsive thoughts and behaviour. Typically, people with OCD have a tendency to have a more inhibited temperament and avoiding risky or potentially destructive situations. Additionally, individuals with OCD tend to be overly redundant with consequences of their actions and tend to not be impulsive. Not surprisingly, people with OCD exhibit unusually low rates of novelty seeking behaviour and cigarette smoking.
There is a robust amount of evidence that ADHD and OCD are characterised by abnormal brain activity in the same neural circuit. Specifically, both conditions exhibit opposite patterns of brain activity in the frontostriatal system [1], the segment of the brain responsible for higher order, motor, cognitive and behavioural functions. However, similarities between OCD and ADHD are limited to only which part of the brain is affected; patients with OCD exhibit significantly increased activity (hypermetabolism) in the frontostriatal circuits, meaning this part of the brain is overactive in people with OCD, while patients with ADHD exhibit decreased activity (hypometabolism), which means this part of the brain is less active in people with ADHD.
While the disorders are associated with very different brain activity patterns, the resulting cognitive effects are somewhat similar, especially in executive functions [2], such as response inhibition, planning, task switching, working memory and decision making. Patients with both OCD and ADHD have consistently and significantly underperformed in tests of such skills.
Research has suggested that OCD and Obsessive-Compulsive Spectrum Disorders fall upon a compulsive-impulsive continuum. In other words, there exists a gradient of disorders, ranging from behavioural impulsivity to compulsivity. OCD appears to lie at the compulsive end of this spectrum, while ADHD exists at the impulsive end. This is surprising, taking into account that over 35 studies have reported an average of 21% of children and 8.5% of adults with OCD also have ADHD.
A question arises : can one person be both impulsive and careful — a person who both takes and avoids risks — and exhibits opposite patterns of brain activity simultaneously ? As a secondary question, if this is indeed possible, how can we account for the significant decrease in reported comorbidity rates in adulthood ? Do two thirds of children diagnosed with both disorders get rid from one of the conditions ? These two questions were at the focus of the research into the association between ADHD and OCD by Dr. Amitai Abramovitch and Andrew Mittelman.
In order to answer the first question, they examined the hypothesis that different mechanisms in OCD and ADHD might result in similar cognitive impairments, in other words, despite the disorders are associated with different patterns of brain activity, they may result in the similar effects on a person’s cognitive functioning. This hypothesis is in line with other research suggesting that very different disorders are characterised by impairments in executive functions, although they might differ in patterns of brain activity and clinical picture. For example, in spite of very different symptoms, post-traumatic stress disorder, major depressive disorder, panic disorder, schizophrenia and bipolar disorder are all characterised by impairments in executive functions and abnormal patterns of brain activity. Additionally, across conditions, trait and state anxiety has been associated with cognitive impairments. Thus, aforementioned researchers have proposed an “Executive Overload model of OCD.”
The Executive Overload model suggests that OCD patients experience an “overflow” of obsessive thoughts. This overflow (which was found to correlate with increased frontostriatal brain activity), results in an overload upon the executive system, which is reflected in executive impairment, resulting in changes to a person’s behaviour and abilities. Generally, anxiety is known to put strain on the executive system, and Dr. Abramovitch and Andrew Mittelman argue that obsessions may be similar to anxiety in regards to their associated cognitive ‘cost.’ Specifically, individuals with OCD are demonstrating deficits that aforementioned scientists believe are actually caused by symptoms themselves.
A good analogy for the OCD Executive Overload model would be a computer’s RAM. The more background processes take place, the less processing power is available to support computations (think of your browser window crashing because you have too many programs running). In OCD, a person may perform a certain task while at the same time experiencing a surge of intrusive thoughts. Thus, the more obsessive, intrusive thoughts that an individual experiences in a given moment, the fewer resources would be available for other tasks (like listening to a teacher in class or concentrating during a business meeting), especially complex ones. In other words, cognitive impairments in OCD are largely state-dependent; thus, the model predicts that treating and reducing OCD symptoms ought to be accompanied by an improvement of executive functioning.
This progression has indeed been observed in patients undergoing OCD treatment where, in conjunction with clinical improvement, CBT resulted in decreased abnormal brain activity and improvement in cognitive symptoms. Researchers’ direct comparison of ADHD and OCD groups yielded an association between Obsessive-Compulsive (OC) symptoms and executive function impairments only within the OCD group and not in the control or ADHD groups. Aforementioned scientists observed that deficient performance on tests of executive functions was correlated with the presence of OC symptoms, but only within the OCD group. In other words, for people with OCD, an increase in reported obsessive/compulsive thoughts and behaviour also meant a decrease in performance on executive function tests, such as ability to suppress responses.
However, in the ADHD group, more OC symptoms were actually correlated with better performance in tests of executive functions — one hypothesis has suggested that this may be because individuals with ADHD who exhibit OC traits as well are better organised and more attentive to details than individuals with ADHD who exhibit no OC symptoms.
In the second study, Andrew Mittelman and Dr. Abramovitch examined the nature of ADHD symptoms throughout the lifespan. They noted that ADHD symptoms were correlated between childhood and adulthood in ADHD and control groups, but not in the OCD group. This second study suggests that some attention problems in children and adolescents might actually stem from OCD symptoms, and are not related to ADHD.
The second question regarding comorbidity of OCD and ADHD has yet to be answered. Upon reviewing literature, it could be understood that, firstly, research reporting prevalence rates of ADHD-OCD co-occurrence exhibits significant inconsistency with reports ranging from 0 % to 59 % of concomitant OCD/ADHD diagnosis. Whereas research suggests that one out of five children with OCD has co-occurring ADHD, but only one out of every 12 adults with OCD has ADHD. So, what happens to half of the children with OCD who initially diagnosed with ADHD as well ; does it disappear in adulthood ? The answer appears to be both affirmative and negative. It appears that preadolescent children with OCD go through a slower brain development process, in which brain activity patterns and associated symptoms may resemble symptomatic description of ADHD. However, through adolescence this arrested development begins to abate as ADHD-like symptoms dissipate and brain activity changes to fit those of adults with OCD. Furthermore, according to Dr. Amitai Abramovitch and Andrew Mittelman, a full-blown dual diagnosis of ADHD and OCD in adults might be rather rare, and is usually associated with a mediating condition (notably chronic tic disorder or Tourette Syndrome).
The way in which neuropsychological disorders manifest in a person’s behaviour is universal. For instance, a deficit in attention, regardless of the cause or condition, may cause an individual to appear as if he is not listening when spoken to directly (which is one of the DSM criteria for ADHD). In light of deficits in attention and executive functions seen in both OCD and ADHD, it is easy to see how a clinician might potentially misdiagnose one condition for another. In fact, chances of misdiagnosis might be even higher in children and young adolescents, whose diagnosis relies heavily on parents or teachers.
Consider the example of a child with OCD who sits in class obsessing over an OCD trigger. Continuously bothered by an overflow of obsessive-intrusive thoughts, this child cannot be attentive in class and would possibly receive lower grades. In turn, the teacher might perceive this student as inattentive and could report to a counsellor and parents that the student might have ADHD. In order to treat the supposed ADHD, a clinician may prescribe stimulant medication (e.g., Ritalin). Several studies suggest that stimulant therapy may exacerbate obsessive-compulsive thoughts and behaviour, or even induce them. Instead of improvement, child’s condition would likely deteriorate. In fact, this may be intuitively explained ; stimulant therapy increases frontostriatal brain activity, which is generally reduced in ADHD, but increased in OCD. Stimulant medication will continue to activate an already hyperactive brain (specifically the frontostriatal system), potentially resulting in immediate aggravation of symptoms. Another possible explanation, once suggested in the scientific literature, is that under the influence of stimulants individuals with OCD may experience improved attention towards obsessive thoughts, potentially resulting in an increase in obsessions, and an in increase in compensatory compulsive rituals.
Neurotransmission System Health
Previously I wrote an article and filmed a video on OCD and misophonia, and explained how a brain neurotransmission system is connected with such neuropsychiatric disorders, and mental well-being in general. As we’ve learned, neurotransmitting system also plays a crucial role in ADHD. It is fairly reasonable to apply principles of health of neurotransmission system to a well-being of a person with ADHD, especially when talking about dopamine — which, as written above, plays an important role in ADHD.
I encourage you to get acquainted with the material regarding this matter I have previously provided, since it could just be the key to a drastic improvement.
Interview with Dr. Mohamed Al Mongi
Specially for Fun Sci Club I interviewed Dr. Mohamed Al Mongi Abdu Al Mursi, a psychiatrist, on the topic of ADHD. I, however, have not proceeded with a full interview with Dr. Mohamed al Mongi due to the time restriction, but I managed to film a decent bit. The interview is available solely in the video.
Interview with Lubov Nikolaevna
I interviewed Lyubov, a psychologist, as well. This interview is to be found below.
Arthur: Today I’m talking with psychologist Lyubov Nikolaevna. Hello, Lyubov.
Lyubov: — Hello, Arthur.
Arthur: All right, let’s begin.
ADHD is considered incurable. The best outcome someone can reach is a stable remission.From your perspective, how stable and long-lasting can the best possible remission be?
And what about a more typical stable remission — how long does that usually lasts for someone with ADHD? and how stable it is?
Lyubov: Yes, ADHD is a condition that can’t be cured because it’s tied to how the brain is wired — and that starts developing even before birth. So, a person lives with it their whole life.
In this case, “remission” isn’t really the right word — it’s more about adaptation.
Over time, a person learns to live with the brain they have.
Also, since our brains are quite plastic, sometimes other areas of the brain can take over certain functions — and that can help someone start behaving in a more or less neurotypical way.
Or they can intentionally develop specific skills to make up for what their brain structure lacks — which can also help them function more normally.
So, in terms of how long that “remission” can last — it can actually last a lifetime.If those skills are solid, and if the brain has adapted, it can be stable.
But a major stress, aging, or other changes can cause a setback.And when that happens, they’ll have to relearn, adapt again, and figure out how to live with themselves all over.
Arthur: As a psychologist, how do you usually work with clients who have ADHD?
Lyubov: Usually, I focus on acceptance.
More often than not, we’re not working directly with ADHD itself — we’re working with the consequences.
Because their brain works differently, their behavior is different, and that often leads to rejection — people don’t accept them.
And over time, that builds up emotional trauma, problems, and that’s mostly what we work through. It’s important to remember that someone with ADHD doesn’t have the same kind of attention as a neurotypical person.
So you have to adjust for that — they might get distracted mid-session, or need to fidget with something, or even walk around the room.
And that’s totally fine — it doesn’t stop them from talking about what’s bothering them.
Arthur: So, it’s hard for them to accept themselves?
Lyubov: Yes.
Arthur: You know, I’ve dealt with that myself.
I have ADHD too, and for a long time I just couldn’t accept myself.
But once I got the diagnosis, it finally started to make sense — I understood what was going on with me.
Lyubov: Yes, these days a lot of people say things like, “Why would you label yourself with a diagnosis? It’s a life-long stigma.”
But in reality, once you understand what’s happening with you, it becomes much easier to live with it. You can start building your life in a way that actually works for you — something that feels more comfortable.
Arthur: From a psychologist's perspective, is it easier or harder to work with clients who have ADHD, compared to clients with other conditions ?
Lyubov: That’s hard to say.
I’ve worked with all kinds of people — with kids on the autism spectrum, with those who have cerebral palsy, and so on.
Of course, there are conditions that are much more difficult than ADHD.
But it really depends on what exactly you're working with.
If it’s just a psychological consultation, then you need to understand the person’s specific traits. You need to pay attention to things like — they might walk around during the session, or keep fidgeting with something in their hands...
Arthur : Like playing with something.
Lyubov: Exactly — playing with something.
Their attention might seem scattered — not always, but it can come and go.
Arthur : So, like, very unfocused?
Lyubov: Yes, thank you — unfocused.But it can also swing the other way — like a kind of hyper…
Arthur: ...focus?
Lyubov: Yes, hyperfocus.
Arthur: Like I’m doing right now, even in this interview.
Lyubov: Yes, so it’s not always easy — because you’re working with someone who’s fundamentally different from the norm.
But at the same time, it’s interesting in its own way.
Arthur : I’m glad you find it interesting — that’s important. Do you think behavioral therapy is effective for clients with ADHD?
Lyubov: Yes, behavioral therapy is very important.
At the very least, when you do group sessions, for example — you bring together people with ADHD, and they share their experiences: how they organize their lives, what symptoms they have.
And that alone can lower anxiety, because they see they’re not alone — there are others like them.Some people manage it, some even thrive with it.
So, group therapy, in particular, is really helpful for easing anxiety.
Arthur: And it also helps with self-acceptance, right?
Lyubov: Yes, it actually helps a lot with that.
Wait — could you repeat your question one more time?
Arthur: Do you think behavioral therapy is particularly effective for people with ADHD?
Lyubov: Yes — actually, I meant to come back to that word, “behavioral.”It’s really important.
Because it helps the person step back and observe their behavior from the outside — analyze it.And that can lead to real change — they might adjust how they act and build patterns that actually make their life more manageable and comfortable.
Arthur: What kind of alternative therapies would you recommend for people with ADHD?
Lyubov: If we’re talking about alternatives — well, for the most part, I’d say time management. It’s something they really need to learn, because attention is such a challenge.
But when you say “alternative,” what exactly do you mean?
Arthur: Well, I mean things that maybe aren’t officially prescribed — like non-traditional approaches.Meditation, for example.
Lyubov: Well, meditation — that’s definitely a challenge for someone who struggles to stay focused. It requires sustained attention, which isn’t easy for them.
I’d probably recommend starting with something like gestalt therapy, or even a more traditional approach.
Because when your behavior stands out from others’, it leaves a mark. It can cause all kinds of issues — trouble fitting in socially, problems in the family, in school, in relationships.
So first, it’s important to work through all the emotional baggage that’s piled up because of that.Then maybe look into group sessions — something that helps with social skills, building connections with different types of people.
Trainings like that can really be beneficial.
As for meditation — yes, it can be great if they can manage it. That’s a big “if,” though.
Arthur: So, just how common is the ADHD diagnosis?
Lyubov: ADHD is actually very common.
Roughly one in ten children has it.
On average, about 20% of the population shows some form of this brain structure difference.
Arthur: population..?
Lyubov: population of a country.
For example, in Russia, the rate is between 15 and 28%.
In the U.S., it’s somewhere around 5 to 13%.
Arthur: Would you say ADHD is a serious condition?
And what’s the hardest part of living with ADHD, from your experience?
Lyubov: Well, how serious it is, really depends on how strongly it shows up. It can be mild — almost unnoticeable.
Or it can be severe, where it clearly affects daily life.
But I wouldn’t say it’s the worst thing that could happen to a person.
It’s a challenge — something you have to work through, shape your life around, to give it some direction. It’s definitely not easy.
But it’s not a life sentence.
So, there’s no need to be afraid of it.
Arthur: What would you say is the hardest part for someone living with ADHD?
Lyubov: Probably connecting with other people.
Because when you’re not like everyone else, it takes time to realize that you’re not bad — you’re just different.
Arthur: How common is ADHD in adults compared to children?
Lyubov: Let me go back to what I said earlier — ADHD is a difference in brain structure. So, if someone is born with it, they’ll have it for life.
It might look different in adulthood, though.
Because over time, people learn coping strategies and build skills that help compensate. Sometimes even age-related changes can work in their favor.
Or the brain adapts — thanks to its plasticity — and brings their behavior closer to what's considered typical.
But the root of it — what they were born with — that never really goes away.
Arthur: I’ve read quite a bit about ADHD.
And from what I’ve gathered, it seems ADHD is diagnosed less often in adults than in kids.Some experts say it’s because the brain actually adapts over time, so the symptoms show up less.Others believe ADHD just kind of disappears — there’s no clear consensus.
Lyubov: There’s also this point — someone with ADHD might have less concentration at first. So they take longer to learn things that come naturally to neurotypical people.
But given enough time, they do learn them.
And as they grow older, they might end up seeming pretty similar to everyone else.
Arthur: Right. How common is comorbidity in people with ADHD?
What other conditions usually show up alongside it?
Lyubov: ADHD often comes with quite a few comorbid conditions, actually.
For example, people might also experience tics, depressive disorders, or full-on depression.There can be developmental delays — both mental and speech-related.
Learning difficulties are also pretty common, as well as emotional regulation issues.And on top of that, substance use disorders can sometimes be part of the picture too.
Arthur: What would you like to say to people with ADHD?
Lyubov: I’d like to say — you’re wonderful people.
You just need to understand yourselves, accept who you are, and learn how to live in harmony with that.
Arthur: On that beautiful note, we’ll wrap up our interview.Thank you, Lyubov.
Lyubov: Thank you, Arthur. It was a pleasure talking with you.
Arthur: Likewise.
My History with ADHD (And a Lot of Other Stuff)
I was not diagnosed with ADHD until recently, when I realised, I have ADHD and booked a psychiatrist appointment to confirm it, although I do have ADHD all my life I could remember. It’s just I face much more exhausting and challenging health issues, and nobody found out a cause of my ADHD symptomatic picture in my childhood, which was there all along.
I have ADHD, predominantly, inattentive type. And boy did I get a great time with my condition.
I always had difficulties sustaining attention, I constantly daydream, and my ADHD greatly synergises with my OCD to ensure my focus is very easily distracted by unwanted thoughts. I have a complex clinical picture with OCD and ADHD entangled and diffused as if it was an unthinkable alloy of intrusive obsessive-compulsive noisy thing.
I was often told that I am inattentive, do not listen when spoken to, always daydream ; I was often accused of such, shouted at (when I was small), et cetera. Since I was little.
Years went by, and my health issues were piling up. When I was about nineteen, I, through combining antibiotics and experimenting with diets, somehow managed to screw up what appears to be my neural connections between my GI and brain. At least that’s what I’ve been told by doctors when I went through a series of thorough tests to check if my GI tract (like hiatus hernia) is somehow responsible for the nausea, I acquired back then in 2017/18.
Long story short, ever since the end of 2017, I suffer from nausea and limited appetite. I have a constant nausea at lowest levels, aggravating to much stronger nausea should I eat more often or more in quantity than I should, or if I drink water or something non-acidic, or be stressed, etc.
My life has changed ever since.
It was already quite grim ever since my OCD started growing, back in about 2012 (especially before I discovered a system of keeping OCD at bay).
I spent years, now developing system to keep nausea at bay. It was a lot of time, effort and suffering. Years of being unable to eat normally, feeling the nausea that just won’t go away — it’s hard to describe it at this point.
First, I thought this was a symptom of gastritis and tried to treat myself with PPIs. Well, it turns out lessening the stomach acid only aggravated the problem drastically. There were times when I ate only some small portion of cold oatmeal on water, and sometimes, a banana — still feeling nauseated. Of course, there was a significant deficit of energy and nutritional intake. I was very slim and struggling to be, as I, of course, felt fatigue due to lack of calories (and still tried to go to gym).
When the stomach got healed almost completely, and a couple of years passed, it was apparent the stomach lining wasn’t the problem. The main suspect then was a hiatus hernia. But this was refuted at a later point in life.
Regarding the nausea — it got only worse when I developed a second kind of nausea, now associated with problem with intestines — which is even more excruciating.
This battle goes on per this very day (Hello from 09.07.2025, I’m much better now ! Although the nausea and lack of appetite did not go away completely, the condition improved on my meds ! Since around two years !), but what I was leading to, is that after I developed the nausea, I also developed self-blaming character due to “Pavlov’s dog” conditioning phenomenon.
When I made mistakes, such as when I drank water or tea after food, or when I tried to eat something in between meals or when not being hungry, or more than required, I entered a nauseous state, where my background nausea increased tenths fold and wouldn’t disappear for hours, sometimes day(s).
Immediately, I started blaming myself, because obviously, I did not want to feel a lasting nausea.
As time went by, self-blaming became a habit. The more time passed, the more grew this phenomenon. I started blaming myself for virtually everything, including ADHD symptoms. I told myself horrible things, I told myself I was defective, unable to do anything right. I blamed myself for ruining my own life. And this did not end at words. This went on and on, and grew pretty grotesque. There were increasingly frequent and continuous meltdowns, as I went psycho on myself.
I was involved in an abusive relationship, where my constant self-blame was aggravated and used against myself. It was a treacherous mechanism, a large psychological hook, thanks to which I thought I was the problem, as I always was. My crumbling sense of myself and self-respect were challenged even more.
In this relationship I allowed grotesque things to happen, and afterwards, in order to forgive myself, I told myself I am never going to treat myself this way again. When you treat yourself badly, you allow others to do the same thing.
Thick bottom-line here I was leading to is that if you suffer from ADHD or any other health disorder, you are not defective. Your brain is wired this way; it is not your fault. You are not wrong to be inattentive and forgetful. You are not wrong to have impulsive urges. It is, however, under your control to attend CBT sessions, take your meds, visit psychotherapist. But that doesn’t mean you must do it, or magically and abruptly become an attentive non-forgetful and non-impulsive person.
Your disorders are not signs of inferiority, on the contrary, they show how strong you are to withstand hardships ; that you can live a life and go forward in spite of such difficulties.
Afterword
Welp, these article and video were made during OCD relapse, hence the pause. And do you know why ? Because I was not following the ‘clean brain’ strategy ! When it comes to neuropsychiatry, it is really important to keep your brain in a healthy state ! Thus, I very much encourage you to check out my article, which explains this subject.
At Fun Sci Club, you can expect further major articles, accompanied by videos on various science and health subjects, as well as debunking pseudoscience, bad science and just pure nonsense people tend to believe in (which also tends to cost them a fortune). You can already find various ‘hot’ scientific articles on the website (which usually come in Russian).
Fun Sci Club is a source of reliable science, the information that was fact-checked and well referenced. Information that will not be silenced. The project is evolving and expected to grow vastly. You can subscribe at the website/channel not to miss out on something important and/or interesting !
This article was not funded by anyone and does not include any paid or unpaid promotions. You are welcome to share/distribute this article, if you properly reference its author (me) and source.
AfterAfterword
It’s been more than a year since this article and video is under production, and the main reason for this is me searching for an English-speaking psychologist to take an interview from, which, as it turns out, isn’t exactly an easy task in the town of Hurghada. I was waiting for one great psychologist I know to free up, which led me nowhere. Eventually, I discovered another great psychologist with the same name, and after a while, filmed an interview, although Lyubov’ (the psychologist), did not speak English at the level satisfactory for the interview to take place, and the video had to be translated to English. All that being said, all the process is finally over, and you can expect new articles and videos coming faster next time 😊
And another great thing — I discovered an awesome psychologist to work with !
References
Some of the sources I used, when writing this article :
Комментарии