🎙️ Introduction

Hello and welcome to Cadabam’s Insights.

One more episode and one more important topic.
Today, we are discussing Attention Deficit Hyperactivity Disorder (ADHD)—a condition many people believe they have today.

Is ADHD really becoming more common, or is awareness and self-diagnosis playing a role?

To help us understand this better, we are joined by Dr. Vishal Kasal, Consultant Psychiatrist. After completing his MBBS, Dr. Vishal trained at NIMHANS, one of India’s premier mental health institutes, where he completed his post-graduation in Psychiatry. He works extensively with adolescents and adults across a wide range of psychiatric conditions.

Welcome to Cadabam’s Insights, Dr. Vishal.

🧠 ADHD in the Age of AI & Online Information

Dr. Vishal:
There is definitely much more awareness today. Earlier, fewer people came seeking help for attention-related concerns.

Now, with easy access to online information, people often research their symptoms and arrive with a self-diagnosis—sometimes suspecting ADHD, sometimes anxiety or depression. Many come with questions rather than conclusions, which is a positive change.

🎯 What Is Attention?

Attention is the brain’s ability to focus on one stimulus while filtering out others.

For example, during a conversation, attention allows me to focus on the person speaking and ignore surrounding noises, lights, or distractions.

Normal Attention Span

• 2-year-old: 2–3 minutes
• Increases by ~1 minute per year
• Young adults (20–25 years): ~25–30 minutes

After around 25 years, attention span plateaus naturally and needs conscious effort and practice to improve further.

🧠 Brain Mechanisms Behind Attention

There are two types of attention:

1️⃣ Bottom-Up Attention

• Stimulus-driven (sounds, light, touch)
• Controlled by the brainstem and limbic system

2️⃣ Top-Down Attention

• Goal-directed (studying, reading, planning)
• Controlled by the prefrontal cortex

🚩 When Does Attention Become a Problem?

Attention becomes problematic when it interferes with daily functioning, such as:

• Inability to complete tasks
• Difficulty learning or concentrating
• Frequent distraction during important activities

For example, procedural tasks like driving may feel automatic, but learning or reading requires active attention. Difficulty here signals a potential issue.

⚡ What Is Hyperactivity?

Hyperactivity is a relative concept, assessed based on:

• Age-appropriate behavior
• Impact on daily life
• Occurrence across multiple settings (school, home, social situations)

Examples include:

• Inability to sit quietly
• Excessive restlessness
• Interrupting others
• Difficulty waiting for turns

📚 Is ADHD a New Condition?

No. ADHD has been recognized for decades in diagnostic manuals such as DSM and ICD.

Prevalence

• Children: 5–7%
• Adults: 2–3%

The condition hasn’t necessarily increased—but awareness, screen exposure, and help-seeking behavior have.

📱 Impact of Digital Devices

Increased screen time is associated with:

• Reduced attention span
• Worsening of existing ADHD traits

ADHD exists on a spectrum—screen exposure may not cause it but can exacerbate symptoms.

🧩 Core Domains of ADHD

ADHD affects three main areas:

1. Inattention
2. Hyperactivity
3. Impulsivity

Impulsivity Includes:

• Acting without considering consequences
• Difficulty delaying gratification

In adults, hyperactivity often reduces, but inattention and impulsivity persist.

👶 ADHD in Children: When to Be Concerned

Red flags include:

• Persistent difficulty focusing (≥6 months)
• Decline in academic performance
• Frequent complaints from school
• Social conflicts and impulsive behavior
• Emotional distress (anxiety, sadness)

Symptoms must be present in multiple settings and affect daily functioning.

🧑‍🦱 ADHD in Adults

Adults may present with:

• Chronic procrastination
• Difficulty meeting deadlines
• Impulsivity
• Poor planning and organization
• Mood issues or substance use

Many adults are diagnosed late, often when seeking help for anxiety, depression, or addiction.

🧬 Causes of ADHD

ADHD is multifactorial:

Brain Differences

• Reduced gray matter thickness in the prefrontal cortex
• Delayed brain maturation (myelination)
• Altered frontostriatal circuits

Genetics

• Heritability: 70–80%
• Dopamine-related genes (DRD, DAT genes)

Environmental Factors

• Prenatal exposure to smoking or alcohol
• Premature birth or low birth weight
• Childhood trauma, abuse, or chronic stress

🔍 How ADHD Is Diagnosed

Diagnosis is clinical, based on:

• Detailed history
• Behavioral assessments
• Standardized scales (e.g., Conners, DIVA)

🧪 No blood tests or brain scans currently diagnose ADHD.

🛠️ Treatment Options

1️⃣ Non-Medication Approaches

• Occupational therapy
• Attention-building activities
• Sports and physical exercise
• Yoga and meditation
• Cognitive Behavioral Therapy (CBT)
• Family counseling
• Reducing screen time
• Structured routines

2️⃣ Medications (When Needed)

Used when symptoms significantly impair functioning.

Types:

• Stimulants: Methylphenidate
• Non-stimulants: Atomoxetine, Clonidine, Guanfacine

Common Side Effects (usually mild):

• Reduced appetite
• Sleep disturbances
• Mild irritability

❌ Not addictive
✔️ Typically reviewed after ~1 year with gradual tapering

Medication works best alongside therapy, not alone.

🌱 Living Well with ADHD

ADHD is manageable.

With the right combination of:

• Therapy
• Skill-building
• Family support
• Medication (if required)

People with ADHD can lead successful, fulfilling lives.

🧠 Final Advice

If you suspect ADHD:
➡️ Get assessed professionally
➡️ Avoid self-diagnosis
➡️ Early intervention improves outcomes

🙏 Closing

Thank you, Dr. Vishal, for this insightful and comprehensive discussion.

If you or your child are facing attention-related challenges, professional help can make a real difference.

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