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115-405: Attention deficit hyperactivity disorder ( ADHD ) is a neurodevelopmental disorder characterized by executive dysfunction occasioning symptoms of inattention , hyperactivity, impulsivity and emotional dysregulation that are excessive and pervasive, impairing in multiple contexts, and developmentally-inappropriate . ADHD symptoms arise from executive dysfunction, and emotional dysregulation

230-466: A dysfunctional family or a poor educational system , rather than any true presence of ADHD in the individual. In other cases, it may be explained by increasing academic expectations, with a diagnosis being a method for parents in some countries to obtain extra financial and educational support for their child. Behaviours typical of ADHD occur more commonly in children who have experienced violence and emotional abuse. Current models of ADHD suggest that it

345-479: A meta-analysis of 16 studies examining the relative risk of traffic collisions for drivers with ADHD, finding an overall relative risk estimate of 1.36 without controlling for exposure, a relative risk estimate of 1.29 when controlling for publication bias , a relative risk estimate of 1.23 when controlling for exposure, and a relative risk estimate of 1.86 for ADHD drivers with oppositional defiant disorder and/or conduct disorder comorbidities . In April 2018,

460-399: A caregiver to an infant's signals can help an infant regulate their emotional systems. Caregiver interaction styles that overwhelm a child or that are unpredictable may undermine emotional regulation development. Effective strategies involve working with a child to support developing self-control such as modeling a desired behavior rather than demanding it. The richness of an environment that

575-434: A cause that can be understood mechanistically and treated in a novel way. The sensory overload is treatable with oral potassium gluconate . Research does not support popular beliefs that ADHD is caused by eating too much refined sugar, watching too much television, bad parenting, poverty or family chaos; however, they might worsen ADHD symptoms in certain people. In some cases, an inappropriate diagnosis of ADHD may reflect

690-430: A child is exposed to helps the development of emotional regulation. An environment must provide appropriate levels of freedom and constraint. The environment must allow opportunities for a child to practice self-regulation. An environment with opportunities to practice social skills without overstimulation or excessive frustration helps a child develop self-regulation skills. Several variables have been explored to explain

805-604: A connection between emotional dysregulation at 5 and 10 months, and parent-reported problems with anger and distress at 18 months. Low levels of emotional regulation behaviors at 5 months were also related to non-compliant behaviors at 30 months. While links have been found between emotional dysregulation and child psychopathology, the mechanisms behind how early emotional dysregulation and later psychopathology are related are not yet clear. Smoking, self-harm , eating disorders , and addiction have all been associated with emotional dysregulation. Somatoform disorders may be caused by

920-495: A decreased ability to regulate and experience emotions or an inability to express emotions in a positive way. Individuals who have difficulty regulating emotions are at risk for eating disorders and substance abuse as they use food or substances as a way to regulate their emotions. Emotional dysregulation is also found in people who have an increased risk of developing a mental disorder , particularly an affective disorder such as depression or bipolar disorder . Dysregulation

1035-534: A dimension of symptom severity, subjective distress, and functional impairment. A consequence of this dimensionality is substantial variability in the nature and extent of support a person with ASD requires. A formal diagnosis of ASD requires not merely the presence of ASD symptoms, but symptoms that cause significant impairment in multiple domains of functioning, in addition to being excessive or atypical enough to be developmentally and socioculturally inappropriate. Attention deficit hyperactivity disorder (ADHD)

1150-489: A diminished quality of life and a direct average reduction in life expectancy of 13 years. ADHD is associated with other neurodevelopmental and mental disorders as well as non-psychiatric disorders, which can cause additional impairment. Motor disorders including developmental coordination disorder , stereotypic movement disorder , and tic disorders (such as Tourette's syndrome ), and apraxia of speech . Deficits in any area of information processing can manifest in

1265-559: A distinct attention disorder occurring in 30–50% of ADHD cases as a comorbidity, regardless of the presentation; a subset of cases diagnosed with ADHD-PIP have been found to have CDS instead. Individuals with ADHD are three times more likely to be diagnosed with an eating disorder compared to those without ADHD; conversely, individuals with eating disorders are two times more likely to have ADHD than those without eating disorders. ADHD, trauma , and adverse childhood experiences are also comorbid, which could in part be potentially explained by

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1380-413: A high heritability of 74%, meaning that 74% of the presence of ADHD in the population is due to genetic factors. There are multiple gene variants which each slightly increase the likelihood of a person having ADHD; it is polygenic and thus arises through the accumulation of many genetic risks each having a very small effect. The siblings of children with ADHD are three to four times more likely to develop

1495-562: A lack of emotional regulation skills can cause both internalizing and externalizing behaviors in a sexual context. This may mean violence, which can serve as a strategy for regulating emotion. In a non-violent context, insecurely attached individuals may seek to satisfy their need for connection or to resolve relational issues with sex. Communication can also be hindered, as emotional dysregulation has been linked to an inability to express oneself in sexual situations. This can lead to victimization as well as further sexual difficulties. Thus,

1610-593: A major genetic mutation. There is no biologically distinct adult-onset ADHD except for when ADHD occurs after traumatic brain injury. Inattention, hyperactivity (restlessness in adults), disruptive behaviour, and impulsivity are common in ADHD. Academic difficulties are frequent, as are problems with relationships. The signs and symptoms can be difficult to define, as it is hard to draw a line at where normal levels of inattention, hyperactivity, and impulsivity end and significant levels requiring interventions begin. According to

1725-408: A meta-analysis reviewing 40 voxel-based morphometry studies and 59 functional magnetic resonance imaging studies comparing subjects with IGD or ADHD to control groups that found that IGD and ADHD subjects had disorder-differentiating structural neuroimage alterations in the putamen and orbitofrontal cortex (OFC) respectively, and functional alterations in the precuneus for IGD subjects and in

1840-512: A mood disorder. When parents have difficulty with regulating their emotions, they often cannot teach their children to regulate properly. The role of parents in a child's development is acknowledged by attachment theory , which argues that the characteristics of the caregiver-child relationship impact future relationships. Current research indicates that parent-child relationships characterized by less affection and greater hostility may result in children developing emotional regulation problems. If

1955-495: A more specific neurodevelopmental manifestation. Some deficits may be predicted from observed deviations in the maturation patterns of the infant gut microbiome . Deprivation from social and emotional care causes severe delays in brain and cognitive development. Studies with children growing up in Romanian orphanages during Nicolae Ceauşescu 's regime reveal profound effects of social deprivation and language deprivation on

2070-659: A neurological condition characterised by recurrent seizures. There are well established associations between ADHD and obesity, asthma and sleep disorders, and an association with celiac disease. Children with ADHD have a higher risk for migraine headaches, but have no increased risk of tension-type headaches. Children with ADHD may also experience headaches as a result of medication. A 2021 review reported that several neurometabolic disorders caused by inborn errors of metabolism converge on common neurochemical mechanisms that interfere with biological mechanisms also considered central in ADHD pathophysiology and treatment. This highlights

2185-518: A number of differences between ADHD and control brains. Mirroring what is known from structural findings, fMRI studies have showed evidence for a higher connectivity between subcortical and cortical regions, such as between the caudate and prefrontal cortex. The degree of hyperconnectivity between these regions correlated with the severity of inattention or hyperactivity Hemispheric lateralization processes have also been postulated as being implicated in ADHD, but empiric results showed contrasting evidence on

2300-431: A number of genes are involved, many of which directly affect brain functioning and neurotransmission. Those involved with dopamine include DAT , DRD4 , DRD5 , TAAR1 , MAOA , COMT , and DBH. Other genes associated with ADHD include SERT , HTR1B , SNAP25 , GRIN2A , ADRA2A , TPH2 , and BDNF . A common variant of a gene called latrophilin 3 is estimated to be responsible for about 9% of cases and when this variant

2415-419: A parent, guardian, teacher, or other responsible adult has raised concerns to a doctor. Neurodevelopmental disorders may also be confirmed by genetic testing . Traditionally, disease related genetic and genomic factors are detected by karyotype analysis , which detects clinically significant genetic abnormalities for 5% of children with a diagnosed disorder. As of 2017 , chromosomal microarray analysis (CMA)

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2530-423: A person's social interactions and relationships at home, in school, or at their place of employment. The word dysregulation is a neologism created by combining the prefix dys- to regulation . According to Webster's Dictionary , dys- has various roots and is of Greek origin. With Latin and Greek roots, it is akin to Old English tō- , te- 'apart' and Sanskrit dus- 'bad, difficult'. It

2645-470: A primary neurodevelopmental disorder. For example HIV Infections of the head and brain, like brain abscesses , meningitis or encephalitis have a high risk of causing neurodevelopmental problems and eventually a disorder. For example, measles can progress to subacute sclerosing panencephalitis . A number of infectious diseases can be transmitted congenitally (either before or at birth), and can cause serious neurodevelopmental problems, as for example

2760-738: A proportionally greater decrease in the volume in the left-sided prefrontal cortex. The posterior parietal cortex also shows thinning in individuals with ADHD compared to controls. Other brain structures in the prefrontal-striatal-cerebellar and prefrontal-striatal-thalamic circuits have also been found to differ between people with and without ADHD. The subcortical volumes of the accumbens , amygdala , caudate , hippocampus , and putamen appears smaller in individuals with ADHD compared with controls. Structural MRI studies have also revealed differences in white matter, with marked differences in inter-hemispheric asymmetry between ADHD and typically developing youths. Functional MRI (fMRI) studies have revealed

2875-641: A psychiatric facility, is recommended. Emotional dysregulation tends to present as emotional responses that may seem excessive compared to the situation. Individuals with emotional dysregulation may have difficulty calming down, avoid difficult feelings, or focus on the negative. On average, women tend to score higher on scales of emotional reactivity than men. A study at University College in Ireland found that dysregulation correlates to negative feelings about one's ability to cope with emotions and rumination in adults. They also found dysregulation to be common in

2990-496: A rate of 21% in those with ADHD, affects social skills, ability to communicate, behaviour, and interests. Learning disabilities have been found to occur in about 20–30% of children with ADHD. Learning disabilities can include developmental speech and language disorders, and academic skills disorders. ADHD, however, is not considered a learning disability, but it very frequently causes academic difficulties. Intellectual disabilities and Tourette's syndrome are also common. ADHD

3105-621: A relationship, and jealous or idealizing feelings towards others. These feelings may be accompanied by support-seeking behaviors such as clinging, smothering, or seeking to control. The counterpart of emotional dysregulation, emotional regulation, strengthens relationships. The ability to regulate negative emotions in particular is linked to positive coping and thus higher relationship satisfaction. Emotional regulation and communication skills are linked to secure attachment, which has been related to higher partner support as well as openness in discussing negative experiences and resolving conflict. On

3220-593: A role in relationship quality and overall satisfaction. It can be difficult for emotionally dysregulated individuals to maintain healthy relationships. People who struggle with emotional dysregulation often externalize, internalize, or dissociate when exposed to stressors. These behaviors are attempts to regulate emotions but often are ineffective in addressing stress in relationships. This commonly presents itself as intense anxiety around relationships, poor ability to set and sustain boundaries, frequent and damaging arguments, preoccupation with loneliness, worries about losing

3335-415: A sample of individuals not affected by mental disorders. Part of emotional dysregulation, which is a core characteristic in borderline personality disorder, is affective instability , which manifests as rapid and frequent shifts in mood of high affect intensity and rapid onset of emotions , often triggered by environmental stimuli. The return to a stable emotional state is notably delayed, exacerbating

3450-492: A side effect of medications used to treat ADHD. In children with ADHD, insomnia is the most common sleep disorder with behavioural therapy being the preferred treatment. Problems with sleep initiation are common among individuals with ADHD but often they will be deep sleepers and have significant difficulty getting up in the morning. Melatonin is sometimes used in children who have sleep onset insomnia. Restless legs syndrome has been found to be more common in those with ADHD and

3565-609: A slower return to a normal emotional state. This is manifested biologically by deficits in the frontal cortices of the brain. As such, the period after a traumatic brain injury such as a frontal lobe disorder can be marked by emotional dysregulation. This is also true of neurodegenerative diseases. Possible manifestations of emotion dysregulation include extreme tearfulness, angry outbursts or behavioral outbursts such as destroying or throwing objects, aggression towards self or others, and threats to kill oneself . Emotion dysregulation can lead to behavioral problems and can interfere with

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3680-524: A statistically small relationship between children's media use and ADHD-related behaviours exists. In November 2018, Cyberpsychology published a systematic review and meta-analysis of 5 studies that found evidence for a relationship between problematic smartphone use and impulsivity traits. In October 2020, the Journal of Behavioral Addictions published a systematic review and meta-analysis of 40 studies with 33,650 post-secondary student subjects that found

3795-578: A symptom of ADHD for that person. In DSM-5, subtypes were discarded and reclassified as presentations of the disorder that change over time. The individual may also meet the criteria for hyperactivity-impulsivity, but the inattentive symptoms are predominant. The individual may also meet the criteria for inattention, but the hyperactive-impulsive symptoms are predominant. Girls and women with ADHD tend to display fewer hyperactivity and impulsivity symptoms but more symptoms of inattention and distractibility. Symptoms are expressed differently and more subtly as

3910-536: A systematic review of 11 studies where the data from all but one study suggested that heightened screen time for children is associated with attention problems. In July 2022, the Journal of Behavioral Addictions published a meta-analysis of 14 studies comprising 2,488 subjects aged 6 to 18 years that found significantly more severe problematic internet use in subjects diagnosed with ADHD to control groups. Systematic reviews in 2017 and 2020 found strong evidence that ADHD

4025-529: A variety of specific learning disabilities (SLD). It is possible for an individual to have more than one of these difficulties. This is referred to as comorbidity or co-occurrence of learning disabilities. In the UK, the term dual diagnosis is often used to refer to co-occurrence of learning difficulties. There are neurodevelopmental research projects examining potential new classifications of disorders including: The multitude of neurodevelopmental disorders span

4140-502: A weak-to-moderate positive association between mobile phone addiction and impulsivity. In January 2021, the Journal of Psychiatric Research published a systematic review of 29 studies including 56,650 subjects that found that ADHD symptoms were consistently associated with gaming disorder and more frequent associations between inattention and gaming disorder than other ADHD scales. In July 2021, Frontiers in Psychiatry published

4255-518: A wide range of associated symptoms and severity, resulting in different degrees of mental, emotional, physical, and economic consequences for individuals, and in turn families, social groups, and society. The development of the nervous system is tightly regulated and timed; it is influenced by both genetic programs and the prenatal environment. Any significant deviation from the normal developmental trajectory early in life can result in missing or abnormal neuronal architecture or connectivity. Because of

4370-493: Is accompanied by another . Intellectual disability , also known as general learning disability is a disorder that affects the ability to learn, retain, or process information; to think critically or abstractly, and to solve problems. Adaptive behaviour is limited, affecting daily living activities . Global developmental delay is categorized under intellectual disability and is diagnosed when several areas of intellectual functioning are affected. A communication disorder

4485-514: Is dialectical behavioral therapy , a psychotherapy which promotes the use of mindfulness , a concept called dialectics , and emphasis on the importance of validation and maintaining healthy behavioral habits. When diagnosed as being part of ADHD, norepinephrine and dopamine reuptake inhibitors such as methylphenidate (Ritalin) and atomoxetine are often used. A few studies have also showed promise in terms of non-pharmacological treatments for people with ADHD and emotional problems, although

4600-726: Is folic acid deficiency in the mother, a B vitamin usually found in fruits, vegetables, whole grains, and milk products. (Neural tube defects are also caused by medications and other environmental causes, many of which interfere with folate metabolism, thus they are considered to have multifactorial causes.) Another deficiency, iodine deficiency , produces a spectrum of neurodevelopmental disorders ranging from mild emotional disturbance to severe intellectual disability. (see also congenital iodine deficiency syndrome ). Excesses in both maternal and infant diets may cause disorders as well, with foods or food supplements proving toxic in large amounts. For instance in 1973 K.L. Jones and D.W. Smith of

4715-432: Is 12 years. However, research indicates the age of onset should not be interpreted as a prerequisite for diagnosis given contextual exceptions. ADHD is divided into three primary presentations: The table "Symptoms" lists the symptoms for ADHD-I and ADHD-HI from two major classification systems. Symptoms which can be better explained by another psychiatric or medical condition which an individual has are not considered to be

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4830-477: Is a common cause (over 400,000 injuries per year in the US alone, without clear information as to how many produce developmental sequellae) of neurodevelopmental syndromes. It may be subdivided into two major categories, congenital injury (including injury resulting from otherwise uncomplicated premature birth) and injury occurring in infancy or childhood. Common causes of congenital injury are asphyxia (obstruction of

4945-611: Is a neurodevelopmental disorder characterised by executive dysfunction occasioning symptoms of inattention , hyperactivity, impulsivity and emotional dysregulation that are excessive and pervasive, impairing in multiple contexts, and developmentally-inappropriate . ADHD symptoms arise from executive dysfunction, and emotional dysregulation is often considered a core symptom. Difficulties in self-regulation such as time management, inhibition and sustained attention may cause poor professional performance, relationship difficulties and numerous health risks, collectively predisposing to

5060-456: Is a neurodevelopmental disorder characterized by symptoms of deficient reciprocal social communication and the presence of restricted, repetitive, and inflexible patterns of behavior. While its severity and specific manifestations vary widely across the spectrum, autism generally affects a person's ability to understand and connect with others, as well as their adaptability to everyday situations. Like most developmental disorders, autism exists along

5175-482: Is a risk factor for many mental health disorders including depressive disorders, anxiety disorders, post-traumatic stress disorder , bipolar disorder , borderline personality disorder , substance use disorder , alcohol use disorder , eating disorders , oppositional defiant disorder , and disruptive mood dysregulation disorder . Dysregulation is also associated with self-injury, suicidal ideation, suicide attempts, and risky sexual behavior. Emotional dysregulation

5290-446: Is an increased risk of a missed ADHD diagnosis, possibly because of compensatory strategies in said individuals. Studies of adults suggest that negative differences in intelligence are not meaningful and may be explained by associated health problems. In children, ADHD occurs with other disorders about two-thirds of the time. Other neurodevelopmental conditions are common comorbidities. Autism spectrum disorder (ASD), co-occurring at

5405-448: Is any disorder that affects an individual's ability to comprehend , detect, or apply language and speech to engage in dialogue effectively with others. This also encompasses deficiencies in verbal and nonverbal communication styles. Examples include stuttering , sound substitution , inability to understand or use one's native language. Autism , also called autism spectrum disorder (ASD) or autism spectrum condition (ASC),

5520-420: Is associated with functional impairments in some of the brain's neurotransmitter systems , particularly those involving dopamine and norepinephrine . The dopamine and norepinephrine pathways that originate in the ventral tegmental area and locus coeruleus project to diverse regions of the brain and govern a variety of cognitive processes. The dopamine pathways and norepinephrine pathways which project to

5635-524: Is associated with increased suicide risk across all age groups, as well as growing evidence that an ADHD diagnosis in childhood or adolescence represents a significant future suicidal risk factor. Potential causes include ADHD's association with functional impairment, negative social, educational and occupational outcomes, and financial distress. A 2019 meta-analysis indicated a significant association between ADHD and suicidal spectrum behaviours (suicidal attempts, ideations, plans, and completed suicides); across

5750-445: Is associated with other neurodevelopmental and mental disorders as well as non-psychiatric disorders, which can cause additional impairment. While people with ADHD often struggle to initiate work and persist on tasks with delayed consequences, this may not be evident in contexts they find intrinsically interesting and immediately rewarding, potentiating hyperfocus (a more colloquial term) or perseverative responding. This mental state

5865-399: Is both linked to novelty seeking and ADHD. The genes GFOD1 and CDH13 show strong genetic associations with ADHD. CDH13's association with ASD, schizophrenia , bipolar disorder, and depression make it an interesting candidate causative gene. Another candidate causative gene that has been identified is ADGRL3 . In zebrafish , knockout of this gene causes a loss of dopaminergic function in

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5980-441: Is characterised by aggression, destruction of property, deceitfulness, theft and violations of rules. Adolescents with ADHD who also have CD are more likely to develop antisocial personality disorder in adulthood. Brain imaging supports that CD and ADHD are separate conditions: conduct disorder was shown to reduce the size of one's temporal lobe and limbic system , and increase the size of one's orbitofrontal cortex , whereas ADHD

6095-510: Is controversial due to the differences between people with ADHD and the difficulty determining the influence of symptoms, such as distractibility, on lower scores rather than intellectual capacity. In studies of ADHD, higher IQs may be over-represented because many studies exclude individuals who have lower IQs despite those with ADHD scoring on average nine points lower on standardised intelligence measures. However, other studies contradict this, saying that in individuals with high intelligence, there

6210-488: Is frequently confused with the spelling disregulation , with the prefix dis meaning 'the opposite of' or 'absence of'; while disregulation refers to the removal or absence of regulation, dysregulation refers to ways of regulating that are inappropriate or ineffective. There are links between child emotional dysregulation and later psychopathology . For instance, ADHD symptoms are associated with problems with emotional regulation, motivation, and arousal. One study found

6325-798: Is generally understood to be a common symptom of ADHD. 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. Difficulties managing anger are more common in children with ADHD, as are delays in speech, language and motor development. Poorer handwriting

6440-413: Is linked to greater sexual attraction in their male partners. However, difficulties in regulating emotions have been linked to poorer sexual health, both in regards to ability and overall satisfaction. Emotional dysregulation plays a role in nonconsensual and violent sexual encounters. Emotional regulation skills prevent verbal coercion by regulating feelings of sexual attraction in men. Consequently,

6555-700: 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 symptomatologies of ADHD, dyslexia, and dysgraphia, and 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. Certain studies have found that people with ADHD tend to have lower scores on intelligence quotient (IQ) tests. The significance of this

6670-476: Is more prevalent in this age group, and is generally seen to decrease as children develop. During early childhood, emotional dysregulation or reactivity is considered to be situational rather than indicative of emotional disorders. It is important to consider parental mood disorders as genetic and environmental determinants. Children of parents with symptoms of depression are less likely to learn strategies for regulating their emotions and are at risk of inheriting

6785-573: Is no clear data on whether there is a direct relationship between ADHD and suicidality, or whether ADHD increases suicide risk through comorbidities. ADHD arises from brain maldevelopment 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

6900-457: Is not a diagnosis, but an indicator of an emotional or behavioral problem that may need intervention. Attachment theory and the idea of an insecure attachment is implicated in emotional dysregulation. Greater attachment security correlates with less emotional dysregulation in daughters. Moreover, it has been observed that more female teens struggle with emotional dysregulation than males. Professional treatment, such as therapy or admittance into

7015-428: Is often comorbid with disruptive, impulse control, and conduct disorders. Oppositional defiant disorder (ODD) occurs in about 25% of children with an inattentive presentation and 50% of those with a combined presentation. It is characterised by angry or irritable mood, argumentative or defiant behaviour and vindictiveness which are age-inappropriate. Conduct disorder (CD) occurs in about 25% of adolescents with ADHD. It

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7130-460: Is often considered a core symptom. Impairments resulting from deficits in self-regulation such as time management , inhibition , and sustained attention can include poor professional performance, relationship difficulties, and numerous health risks, collectively predisposing to a diminished quality of life and a direct average reduction in life expectancy of 13 years. The disorder costs society hundreds of billions of US dollars each year, worldwide. It

7245-419: Is often due to iron deficiency anemia . However, restless legs can simply be a part of ADHD and requires careful assessment to differentiate between the two disorders. Delayed sleep phase disorder is also a common comorbidity. Individuals with ADHD are at increased risk of substance use disorders . This is most commonly seen with alcohol or cannabis . The reason for this may be an altered reward pathway in

7360-480: Is often hard to disengage from and is related to risks such as for internet addiction and types of offending behaviour. ADHD represents the extreme lower end of the continuous dimensional trait (bell curve) of executive functioning and self-regulation, which is supported by twin, brain imaging and molecular genetic studies. The precise causes of ADHD are unknown in most individual cases. Meta-analyses of studies of twins, families and molecular genetics have shown that

7475-441: Is present, people are particularly responsive to stimulant medication. The 7 repeat variant of dopamine receptor D4 (DRD4–7R) causes increased inhibitory effects induced by dopamine and is associated with ADHD. The DRD4 receptor is a G protein-coupled receptor that inhibits adenylyl cyclase . The DRD4–7R mutation results in a wide range of behavioural phenotypes , including ADHD symptoms reflecting split attention. The DRD4 gene

7590-475: Is related to other chromosomal abnormalities such as translocation of the genetic material. It is characterized by short stature , epicanthal ( eyelid ) folds, abnormal fingerprints , and palm prints , heart defects , poor muscle tone (delay of neurological development), and intellectual disabilities (delay of intellectual development). Less commonly known genetically determined neurodevelopmental disorders include Fragile X syndrome . Fragile X syndrome

7705-598: Is that they negatively impact a person's functioning in one or more domains of life (personal, social, academic, occupational) depending on the disorder and deficits it has caused. All of these disorders and their levels of impairment exist on a spectrum, and affected individuals can experience varying degrees of symptoms and deficits, despite having the same diagnosis. The DSM-5 classifies neurodevelopmental disorders into six overarching groups: intellectual , communication , autism , attention deficit hyperactivity , motor , and specific learning disorders . Often one disorder

7820-540: The International Journal of Environmental Research and Public Health published a systematic review of 24 studies researching associations between internet gaming disorder (IGD) and various psychopathologies that found an 85% correlation between IGD and ADHD. In October 2018, PNAS USA published a systematic review of four decades of research on the relationship between children and adolescents' screen media use and ADHD-related behaviours and concluded that

7935-527: The University of Washington Medical School in Seattle found a pattern of "craniofacial, limb, and cardiovascular defects associated with prenatal onset growth deficiency and developmental delay" in children of alcoholic mothers, now called fetal alcohol syndrome , It has significant symptom overlap with several other entirely unrelated neurodevelopmental disorders. Brain trauma in the developing human

8050-734: 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. The DSM-5 's required age of onset of symptoms

8165-474: The organophosphate insecticides chlorpyrifos and dialkyl phosphate is associated with an increased risk; however, the evidence is not conclusive. Exposure to tobacco smoke during pregnancy can cause problems with central nervous system development and can increase the risk of ADHD. Nicotine exposure during pregnancy may be an environmental risk. Extreme premature birth , very low birth weight , and extreme neglect, abuse, or social deprivation also increase

8280-431: The prefrontal cortex and striatum are directly responsible for modulating executive function (cognitive control of behaviour), motivation, reward perception, and motor function; these pathways are known to play a central role in the pathophysiology of ADHD. Larger models of ADHD with additional pathways have been proposed. In children with ADHD, there is a general reduction of volume in certain brain structures, with

8395-488: The rewards circuit (including the OFC, the anterior cingulate cortex , and striatum ) for both IGD and ADHD subjects. In March 2022, JAMA Psychiatry published a systematic review and meta-analysis of 87 studies with 159,425 subjects 12 years of age or younger that found a small but statistically significant correlation between screen time and ADHD symptoms in children. In April 2022, Developmental Neuropsychology published

8510-421: The trachea ), hypoxia (lack of oxygen to the brain), and the mechanical trauma of the birth process itself. Although it not clear yet as strong is the correlation between placenta and brain, a growing number of studies are linking placenta to fetal brain development. Neurodevelopmental disorders are diagnosed by evaluating the presence of characteristic symptoms or behaviors in a child, typically after

8625-428: The 5:1 male-to-female sex ratio in the epidemiology of ADHD suggests that ADHD may be the end of a continuum where males are overrepresented at the tails , citing clinical psychologist Simon Baron-Cohen 's suggestion for the sex ratio in the epidemiology of autism as an analogue. Natural selection has been acting against the genetic variants for ADHD over the course of at least 45,000 years, indicating that it

8740-420: The ADHD population, as have mood disorders (especially bipolar disorder and major depressive disorder ). Boys diagnosed with the combined ADHD subtype are more likely to have a mood disorder. Adults and children with ADHD sometimes also have bipolar disorder, which requires careful assessment to accurately diagnose and treat both conditions. Sleep disorders and ADHD commonly co-exist. They can also occur as

8855-453: The ability to both recognize emotions and express negative emotions are important for communication and social adjustment, including within sexual contexts. While personal characteristics and experiences can contribute to externalizing and internalizing behaviors as listed above, emotional regulation has an interpersonal aspect. Couples who effectively co-regulate have higher emotional satisfaction and stability. Openly discussing emotions in

8970-419: The brains of ADHD individuals, self-treatment and increased psychosocial risk factors. This makes the evaluation and treatment of ADHD more difficult, with serious substance misuse problems usually treated first due to their greater risks. Other psychiatric conditions include reactive attachment disorder , characterised by a severe inability to appropriately relate socially, and cognitive disengagement syndrome ,

9085-407: The challenge of achieving emotional equilibrium. This instability is further intensified by an acute sensitivity to psychosocial cues , leading to significant challenges in managing emotions effectively. Relationships are generally linked to better well-being, but dissatisfaction in relationships can lead to increased divorce, worsened health, and potential violence. Emotional dysregulation plays

9200-545: The child during gestation . (See also teratology ). In a child, type 1 diabetes can produce neurodevelopmental damage by the effects of excess or insufficient glucose . The problems continue and may worsen throughout childhood if the diabetes is not well controlled. Type 2 diabetes may be preceded in its onset by impaired cognitive functioning. A non-diabetic fetus can also be subjected to glucose effects if its mother has undetected gestational diabetes . Maternal diabetes causes excessive birth size, making it harder for

9315-526: The child's emotional needs are ignored or rejected, they may experience greater difficulty dealing with emotions in the future. Moreover, conflict between parents is linked to increased emotional reactivity or dysregulation in children. Other factors involved include the quality of relationship with peers, the child's temperament, and social or cognitive understanding. Additionally, loss or grief can contribute to emotional dysregulation. Research has shown that failures in emotional regulation may be related to

9430-438: The connection between emotional dysregulation and substance use in young adults, such as child maltreatment, cortisol levels, family environment, and symptoms of depression and anxiety. Vilhena-Churchill and Goldstein (2014) explored the association between childhood maltreatment and emotional dysregulation. More severe childhood maltreatment was found to be associated with an increase in difficulty regulating emotion, which in turn

9545-471: The developing brain. These effects are time-dependent. The longer children stayed in negligent institutional care, the greater the consequences. By contrast, adoption at an early age mitigated some of the effects of earlier institutionalization . A prominent example of a genetically determined neurodevelopmental disorder is trisomy 21, also known as Down syndrome . This disorder usually results from an extra chromosome 21 , although in uncommon instances it

9660-780: The developing child, may produce neurodevelopmental disorders. One typical immune reaction in infants and children is PANDAS , or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection . Another disorder is Sydenham's chorea , which results in more abnormal movements of the body and fewer psychological sequellae. Both are immune reactions against brain tissue that follow infection by Streptococcus bacteria. Susceptibility to these immune diseases may be genetically determined, so sometimes several family members may have one or both of them following an epidemic of Strep infection. Systemic infections can result in neurodevelopmental consequences, when they occur in infancy and childhood of humans, but would not be called

9775-413: 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

9890-607: The disorder than siblings of children without the disorder. The association of maternal smoking observed in large population studies disappears after adjusting for family history of ADHD, which indicates that the association between maternal smoking during pregnancy and ADHD is due to familial or genetic factors that increase the risk for the confluence of smoking and ADHD. ADHD presents with reduced size, functional connectivity and activation as well as low noradrenergic and dopaminergic functioning in brain regions and networks crucial for executive functioning and self-regulation. Typically,

10005-576: The disorder) tends to be much higher. However their usefulness as tools for diagnosis is limited as no single gene predicts ADHD. ASD shows genetic overlap with ADHD at both common and rare levels of genetic variation. In addition to genetics, some environmental factors might play a role in causing ADHD. Alcohol intake during pregnancy can cause fetal alcohol spectrum disorders which can include ADHD or symptoms like it. Children exposed to certain toxic substances, such as lead or polychlorinated biphenyls , may develop problems which resemble ADHD. Exposure to

10120-796: The display of acting out , externalizing disorders , or behavior problems. When presented with challenging tasks, children who were found to have defects in emotional regulation (high-risk) spent less time attending to tasks and more time throwing tantrums or fretting than children without emotional regulation problems (low-risk). High-risk children had difficulty with self-regulation and had difficulty complying with requests from caregivers and were more defiant. Emotional dysregulation has also been associated with childhood social withdrawal. Emotional dysregulation in children can be associated with internalizing behaviors including: Emotional dysregulation in children can be associated with externalizing behaviors including: In adolescents, emotional dysregulation

10235-438: The emotions of children struggling with emotional dysregulation. Training to help parents address this issue focuses on predictability and consistency. These tenets are thought to provide comfort by creating a sense of familiarity and thus safety. While cognitive behavioral therapy is the most widely prescribed treatment for such psychiatric disorders, a commonly prescribed psychotherapeutic treatment for emotional dysregulation

10350-409: The evidence is weak and may apply to only children with food sensitivities . The European Union has put in place regulatory measures based on these concerns. In a minority of children, intolerances or allergies to certain foods may worsen ADHD symptoms. Individuals with hypokalemic sensory overstimulation are sometimes diagnosed as having ADHD, raising the possibility that a subtype of ADHD has

10465-524: The fetus even if the fetus has not inherited the disease. This can produce intellectual disability and other disorders. Nutrition disorders and nutritional deficits may cause neurodevelopmental disorders, such as spina bifida , and the rarely occurring anencephaly , both of which are neural tube defects with malformation and dysfunction of the nervous system and its supporting structures, leading to serious physical disability and emotional sequelae. The most common nutritional cause of neural tube defects

10580-467: The importance of close collaboration between health services to avoid clinical overshadowing. In June 2021, Neuroscience & Biobehavioral Reviews published a systematic review of 82 studies that all confirmed or implied elevated accident-proneness in ADHD patients and whose data suggested that the type of accidents or injuries and overall risk changes in ADHD patients over the lifespan. In January 2014, Accident Analysis & Prevention published

10695-591: The individual ages. Hyperactivity tends to become less overt with age and turns into inner restlessness, difficulty relaxing or remaining still, talkativeness or constant mental activity in teens and adults with ADHD. Impulsivity in adulthood may appear as thoughtless behaviour, impatience, irresponsible spending and sensation-seeking behaviours, while inattention may appear as becoming easily bored, difficulty with organization, remaining on task and making decisions, and sensitivity to stress. Although not listed as an official symptom, emotional dysregulation or mood lability

10810-458: The infant to pass through the birth canal without injury or it can directly produce early neurodevelopmental deficits. Usually the neurodevelopmental symptoms will decrease in later childhood. Phenylketonuria , also known as PKU, can induce neurodevelopmental problems and children with PKU require a strict diet to prevent intellectual disability and other disorders. In the maternal form of PKU , excessive maternal phenylalanine can be absorbed by

10925-401: The majority are of unknown causes. Metabolic disorders in either the mother or the child can cause neurodevelopmental disorders. Two examples are diabetes mellitus (a multifactorial disorder ) and phenylketonuria (an inborn error of metabolism ). Many such inherited diseases may directly affect the child's metabolism and neural development but less commonly they can indirectly affect

11040-1088: The other hand, emotional dysregulation has a negative impact on relationships. Multiple studies note the effects of emotion dysregulation on relationship quality. One study found that relationship satisfaction is lower in couples that lack impulse control or regulatory strategies. Another study found that both husbands' and wives' emotional reactivity was negatively linked with marriage quality as well as perceptions of partner responsiveness. The literature concludes that dysregulation increases instances of perceived criticism, contributes to physical and psychological violence, and worsens depression, anxiety, and sexual difficulties. Dysregulation has also been observed to lower empathy and decrease relationship satisfaction, quality, and intimacy. Research conflicts on whether higher levels of emotional reactivity are linked to increases or decreases in sexual desire. Moreover, this effect could differ between men and women based on observed differences in emotional reactivity between genders. Some research posits that higher emotional reactivity in women

11155-452: The other. Additionally, traumatic events in childhood are a risk factor for ADHD; they can lead to structural brain changes and the development of ADHD behaviours. Finally, the behavioural consequences of ADHD symptoms cause a higher chance of the individual experiencing trauma (and therefore ADHD leads to a concrete diagnosis of a trauma-related disorder). Some non-psychiatric conditions are also comorbidities of ADHD. This includes epilepsy ,

11270-399: 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

11385-769: The rearing family and social environment. Very rarely, ADHD can also be the result of abnormalities in the chromosomes. In November 1999, Biological Psychiatry published a literature review by psychiatrists Joseph Biederman and Thomas Spencer found the average heritability estimate of ADHD from twin studies to be 0.8, while a subsequent family , twin, and adoption studies literature review published in Molecular Psychiatry in April 2019 by psychologists Stephen Faraone and Henrik Larsson that found an average heritability estimate of 0.74. Additionally, evolutionary psychiatrist Randolph M. Nesse has argued that

11500-472: The relationship can help to validate feelings of insecurity and encourage closeness. For partners who struggle with emotional dysregulation, there are available treatments. Couple's therapy has shown itself to be an effective method of improving relationship satisfaction and quality by positively impacting the process of emotional regulation in relationships. Early experiences with caregivers can lead to differences in emotional regulation. The responsiveness of

11615-603: The research is limited and requires additional inquiry. Eye Movement Desensitization and Reprocessing (EMDR) can help recovery from emotional dysregulation in cases where the dysregulation is a symptom of prior trauma . Outside of therapy, there are helpful strategies to help individuals recognize how they are feeling and put space between an event and their response. These include mindfulness, affirmations , and gratitude journaling. Hypnosis may also help to improve emotional regulation. Movement such as yoga and aerobic exercise can also be therapeutic by aiding with regulation and

11730-524: The risk as do certain infections during pregnancy, at birth, and in early childhood. These infections include, among others, various viruses ( measles , varicella zoster encephalitis , rubella , enterovirus 71 ). At least 30% of children with a traumatic brain injury later develop ADHD and about 5% of cases are due to brain damage. Some studies suggest that in a small number of children, artificial food dyes or preservatives may be associated with an increased prevalence of ADHD or ADHD-like symptoms, but

11845-409: The similarity in presentation between different diagnoses. The symptoms of ADHD and PTSD can have significant behavioural overlap—in particular, motor restlessness, difficulty concentrating, distractibility, irritability/anger, emotional constriction or dysregulation, poor impulse control, and forgetfulness are common in both. This could result in trauma-related disorders or ADHD being mis-identified as

11960-440: The studies examined, the prevalence of suicide attempts in individuals with ADHD was 18.9%, compared to 9.3% in individuals without ADHD, and the findings were substantially replicated among studies which adjusted for other variables. However, the relationship between ADHD and suicidal spectrum behaviours remains unclear due to mixed findings across individual studies and the complicating impact of comorbid psychiatric disorders. There

12075-600: The temporal and spatial complexity of the developmental trajectory, there are many potential causes of neurodevelopmental disorders that may affect different areas of the nervous system at different times and ages. These range from social deprivation, genetic and metabolic diseases , immune disorders , infectious diseases , nutritional factors, physical trauma , and toxic and prenatal environmental factors. Some neurodevelopmental disorders, such as autism and other pervasive developmental disorders , are considered multifactorial syndromes which have many causes that converge to

12190-637: The topic. Neurodevelopmental disorder Neurodevelopmental disorders are a group of mental conditions affecting the development of the nervous system , which includes the brain and spinal cord . According to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, ( DSM-5 ) published in 2013, these conditions generally appear in early childhood, usually before children start school, and can persist into adulthood. The key characteristic of all these disorders

12305-583: The ventral diencephalon and the fish display a hyperactive/impulsive phenotype . For genetic variation to be used as a tool for diagnosis, more validating studies need to be performed. However, smaller studies have shown that genetic polymorphisms in genes related to catecholaminergic neurotransmission or the SNARE complex of the synapse can reliably predict a person's response to stimulant medication . Rare genetic variants show more relevant clinical significance as their penetrance (the chance of developing

12420-472: The viruses HSV , CMV , rubella ( congenital rubella syndrome ), Zika virus , or bacteria like Treponema pallidum in congenital syphilis , which may progress to neurosyphilis if it remains untreated. Protozoa like Plasmodium or Toxoplasma which can cause congenital toxoplasmosis with multiple cysts in the brain and other organs, leading to a variety of neurological deficits. Some cases of schizophrenia may be related to congenital infections, though

12535-442: Was also associated with an increase in substance use. Childhood events and family climate with emotional dysregulation are both factors seemingly linked to substance use. Prosek, Giordano, Woehler, Price, and McCullough (2018) explored the relationship between mental health and emotional regulation in collegiate illicit substance users. Illicit drug users reported higher levels of depression and anxiety symptoms. Emotional dysregulation

12650-504: Was associated with a greater likelihood of coping by using marijuana. Kliewer et al. (2016) performed a study on the relationship between negative family emotional climate, emotional dysregulation, blunted anticipatory cortisol, and substance use in adolescents. Increased negative family emotional climate was found to be associated with high levels of emotional dysregulation, which was then associated with increased substance use. Girls were seen to have blunted anticipatory cortisol levels, which

12765-528: Was first described in 1943 by Martin and Bell, studying persons with family history of sex-linked "mental defects". Rett syndrome , another X-linked disorder, produces severe functional limitations. Williams syndrome is caused by small deletions of genetic material from chromosome 7 . The most common recurrent copy number variation disorder is DiGeorge syndrome (22q11.2 deletion syndrome), followed by Prader-Willi syndrome and Angelman syndrome . Immune reactions during pregnancy , both maternal and of

12880-485: Was more prominent in illicit drug users in the sense that they had less clarity and were less aware of their emotions when the emotions were occurring. Many people experience dysregulation and can struggle at times with uncontrollable emotions. Thus, potential underlying issues are important to consider in determining severity. As the ability to appropriately express and regulate emotions is related to better relationships and mental health, parental support can help regulate

12995-575: Was not an adaptative trait in ancient times. The disorder may remain at a stable rate by the balance of genetic mutations and removal rate (natural selection) across generations; over thousands of years, these genetic variants become more stable, decreasing disorder prevalence. Throughout human evolution, the EFs involved in ADHD likely provide the capacity to bind contingencies across time thereby directing behaviour toward future over immediate events so as to maximise future social consequences for humans. ADHD has

13110-1119: Was proposed to replace karyotyping because of its ability to detect smaller chromosome abnormalities and copy-number variants , leading to greater diagnostic yield in about 20% of cases. The American College of Medical Genetics and Genomics and the American Academy of Pediatrics recommend CMA as standard of care in the US. Emotional dysregulation It is often linked to physical factors such as brain injury , or psychological factors such as adverse childhood experiences , and ongoing maltreatment , including child abuse , neglect , or institutional abuse . Emotional dysregulation may be present in people with psychiatric and neurodevelopmental disorders such as attention deficit hyperactivity disorder , autism spectrum disorder , bipolar disorder , borderline personality disorder , complex post-traumatic stress disorder , and fetal alcohol spectrum disorders . In such cases as borderline personality disorder and complex post-traumatic stress disorder, hypersensitivity to emotional stimuli causes

13225-471: Was shown to reduce connections in the cerebellum and prefrontal cortex more broadly. Conduct disorder involves more impairment in motivation control than ADHD. Intermittent explosive disorder is characterised by sudden and disproportionate outbursts of anger and co-occurs in individuals with ADHD more frequently than in the general population. Anxiety and mood disorders are frequent comorbidities. Anxiety disorders have been found to occur more commonly in

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