If you want to deepen your knowledge about ADHD in children, we recommend reading this article👇🏻

🧠 Attention Deficit Hyperactivity Disorder with or without Hyperactivity

Attention Deficit Hyperactivity Disorder with or without Hyperactivity is a neurodevelopmental disorder of neurobiological origin characterized by symptoms associated with inattention, hyperactivity, or impulsivity, symptoms that can occur in isolation or combined, and that typically have a specific and stable cognitive profile throughout the person's life (Onandia-Hinchado and Del Olmo, 2023), which is why the person begins to experience deterioration in a variety of contexts and scenarios (APA, 2013). In the case of adults, these symptoms can affect areas related to family life, socialization, work, difficulty adapting to social norms, regulating behavior, and in romantic relationships (Onandia-Hinchado and Del Olmo, 2023).

🚘 Example of Impulsivity

To give you an idea, an adult with a tendency towards impulsivity may frequently engage in reckless behavior while driving, which can eventually lead to receiving many traffic tickets. We emphasize that not all cases manifest symptoms equally, which is why a neuropsychological evaluation would allow for objectifying how the symptoms are causing deterioration according to the individuality of each reality and person.

☝🏻 Importance of Evaluation

It is important to mention that not every symptom related to attention and executive processes in general is a symptom that exclusively stems from factors linked to neurodevelopment. For example, diagnostic manuals such as the DSM-5 establish that some clinical conditions, such as major depression, may involve a decrease in the ability to think or concentrate. Similarly, factors such as sleep deprivation, history of acquired brain injury, nutrition, emotional factors, prolonged exposure to screens, not dedicating time to self-care tasks, hormonal factors, substance use, alcoholism, unstable routines and habits can be factors that may influence the emergence of symptoms affecting attention processes, hyperactivity, or impulsivity (Onandia-Hinchado and Del Olmo, 2023).

📚 Executive Functions

Closely related to attention, hyperactivity, or impulsivity are executive functions, processes that according to Funahashi and Andreau (2013) are defined as higher-order cognitive processes that allow for the coordination of several neural systems in order to pursue a goal flexibly. For this reason, components of executive functions such as inhibition, working memory, cognitive flexibility, logical reasoning, planning, decision-making, divided attention to various stimuli simultaneously, and processing speed are important. If you wish to deepen your knowledge about executive functions, we recommend reading the following articles:

  • Hot and cold executive functions from the neuropsychological evaluation
  • Neuropsychology of executive functions and their importance in education

▶️ Advances in Neuropsychology

According to Onandia-Hinchado and Del Olmo (2023), advances in neuropsychology present us with other diagnostic frameworks that would be worth evaluating in the presence of symptoms affecting the cognitive profile of individuals. We refer to dysexecutive syndromes, which are a type of cognitive profile that results in an impairment in impulse control (such as in the case of orbital prefrontal syndrome), and impairment in the ability to manipulate information, which can trigger errors, slowness, and a tendency to disconnect from the task, thus losing the objective and efficiency of the activity to be performed (this type of symptom occurs in dorsolateral prefrontal syndrome).

🤓 Considerations about ADHD

Based on all that has been previously written, it is also good to clarify that science is in constant research, and ADHD is recognized as a type of developmental dysexecutive syndrome. However, not every dysexecutive syndrome is considered ADHD. As we have mentioned in this article, a person who has not presented ADHD of neurobiological origin could, due to environmental factors, develop symptoms typical of a dysexecutive syndrome in adulthood. Some environmental factors that can act as risk factors for the emergence of dysexecutive symptoms include: lack of structure in the environment, not organizing beforehand before starting an activity, habits that cause distraction while performing a task (such as looking at your phone while working or driving), acquired brain injury, or substance use can be some factors that may interfere with our everyday cognitive performance.

🧐 Evaluation for ADHD and Dysexecutive Syndromes

What does the evaluation for ADHD and dysexecutive syndromes in adults consist of? Below, we delve into some tests that are commonly used for this purpose:

  • ✅ Diagnostic Interview for ADHD in Adults: To properly evaluate ADHD in adults, it is important to validate that the symptoms have been present since childhood and have remained constant throughout the person's life. Therefore, a retrospective interview should be able to gather data on how these symptoms have been present in childhood and whether they continue to persist in adulthood. If the symptoms have not been present since childhood, as we have mentioned in this article, it is necessary to explore environmental factors to see if there is any risk factor that could be impacting cognitive areas.
  • ✅ Visual Attention (d2-R Test): It is important to evaluate visual attention processes through cancellation tasks. This type of task measures concentration, work speed, and accuracy when executing visual tasks that involve a motor response.
  • ✅ Intelligence in Adults (WAIS-IV): Intelligence should be measured with comprehensive intelligence tests that allow for the measurement of verbal tasks (comprehension, vocabulary, verbal recognition of drawings), abstract reasoning, working memory, and processing speed.
  • ✅ Cognitive Flexibility, Planning, and Organization (Trails Test): Using tests that allow for the evaluation of planning, flexibility, and organization can be achieved through the use of the Trails Test. The definition of planning involves organizing cognitive resources to achieve a task, considering restrictions and feedback received to adjust behavior towards achieving a specific goal. Flexibility refers to seeking alternatives to solve a problem and being able to adjust behavior when results do not align with expectations.
  • ✅ Alternating Attention and Inhibition (Five Digits Test): Inhibition is related to the ability to control the interference of irrelevant stimuli while being able to redirect our cognitive resources to relevant stimuli or objectives. Similarly, alternating attention refers to the ability to attend to and alternate between two types of target stimuli simultaneously. The Five Digits Test is an excellent test for evaluating both inhibition and alternating attention.

🧐 Treatment for ADHD and Dysexecutive Syndromes

What does treatment for ADHD and dysexecutive syndromes in adults consist of?

⭐️ Regarding treatment, initially, International Guidelines such as NICE (National Institute for Health and Care Excellence) recommend starting treatment with psychological therapy, and in cases of more severe symptoms, a combination of psychological therapy and pharmacological treatment. Regarding psychological therapy, cognitive therapy, that is, cognitive training or cognitive stimulation, is recommended. The techniques used in therapy to compensate for attentional or executive deficits should include environmental supports, external aids, self-control strategies, training in various attentional components, and psychosocial support, especially in adults who may have suffered significant brain injury (Arango et al., 2020).

Whether or not you have ADHD or a Dysexecutive Syndrome

Can I do something to improve my concentration, symptoms of hyperactivity/impulsivity?

We reiterate that each case should be evaluated individually; however, in general, people of all ages, including adults, can use the following strategies (click on the blue link to expand with a YouTube Shorts on this topic).

  • ▶️ Pomodoro Technique: A technique that involves using tangible or digital timers to control work time. It is important that when using this technique, we avoid multitasking. Once the work time is finished, we can reward ourselves with a break. During the break, avoid screen time. Instead, we can take an active break, drink water, allow ourselves a short 5-minute nap, or simply socialize with a member of our work or home.
  • ▶️ Use of the One Sec app: The One Sec app allows us to monitor and regulate our inhibition when using the phone. When we try to open an app, it will ask us if we really want to open it. This can be useful for controlling and reducing our screen time while we are doing important work. If you are a parent, this app will also allow you to control screen time for children.
  • ▶️ Recommendations for parents regarding executive functions in children: As adults, we may also need to strengthen executive functions in the younger members of the household. Creating a structured work environment, implementing extracurricular activities, and establishing family board game routines are fundamental allies for strengthening executive functions from the family.

🤩 ADHD Evaluation

If you are interested in an evaluation for ADHD or executive dysfunction for adults, remember that the Integral Center for Educational Neuropsychology is your ally in this type of service. For more information, you can contact us at +507 6535 6362, and we will be happy to assist you.

📚 References

  • ✅ American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC (2013). doi: 10.1176/appi.books.9780890425596
  • ✅ Arango Lasprilla, J. C., Wilson, B., & Olabarrieta Landa, L. (2020): Principles of Neuropsychological Rehabilitation (1st edition). Mexico City. Editorial Manual Moderno.
  • ✅ Funahashi, S., & Andreau, J. M. (2013): Prefrontal cortex and neural mechanisms of executive function. Journal of Physiology, Paris, 107(6), 471-482. https://doi.org/10.1016/j.jphysparis.2013.05.001
  • ✅ Onandia-Hinchado, I., & Del Olmo, A. (2023): Manual of Child and Adolescent Neuropsychology (Second edition). Sara Ediciones.
  • ✅ NICE. (2019): Attention deficit hyperactivity disorder: Diagnosis and management. NICE guideline [NG87]. https://www.nice.org.uk/guidance/ng87