Attention-deficit hyperactivity disorder (ADHD)

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects millions of individuals worldwide, spanning various age groups. Formerly known as attention-deficit disorder (ADD), ADHD is characterized by persistent patterns of inattention, hyperactivity, and impulsivity. These symptoms can interfere significantly with daily functioning, education, and social interactions.

While the disorder is most commonly identified in childhood, it frequently persists into adolescence and adulthood. As of 2022, an estimated 7 million (11.4%) U.S. children aged 3–17 years were diagnosed with ADHD. Boys (15%) were more likely to be diagnosed with ADHD than girls (8%).

Although the evidence is limited, medical cannabis may be utilized to help manage some of the symptoms of ADHD and the side effects of medications. This includes anxiety, depression, insomnia, overuse of stimulants, and lack of focus.

ADHD causes

The exact cause of ADHD is not fully understood, but research highlights a combination of genetic, environmental, and neurological factors as contributing to its development. Key causes and risk factors include:

• Genetics: ADHD often runs in families, suggesting a strong hereditary component
• Brain structure and function: Differences in the brain’s prefrontal cortex, which governs attention and impulse control, have been linked to ADHD. Subperformance of dopamine and norepinephrine receptors may play a role, leading to improperly regulated dopamine and a constant reward-seeking behavior.
• Environmental influences: Prenatal exposure to alcohol, tobacco, or environmental toxins, as well as premature birth or low birth weight, may increase the risk of ADHD
• Other factors: Early childhood adversity or trauma may also play a role in ADHD’s manifestation

ADHD symptoms & health effects

ADHD symptoms can vary widely in severity and presentation. Symptoms presented are typically categorized into two domains:

1. Inattention:
   • Difficulty sustaining focus on tasks or activities
   • Frequent careless mistakes in work or school
   • Forgetfulness in daily routines
2. Hyperactivity and impulsivity:
   • Fidgeting, tapping, or an inability to remain seated
   • Interrupting others during conversations
   • Acting without thinking, or rushing through tasks

From these symptoms, it can be determined if the subtype is one of the following three:

1. Inattententive
2. Hyperactive-impulsive
3. Combined

Health effects

ADHD is often associated with various comorbid conditions and long-term impacts, including:

• • Academic and professional challenges: Struggles with organization and time management may lead to underachievement
  • Emotional health: Increased risk of anxiety, depression, and low self-esteem, as well as mood swings
  • Physical health risks: Higher likelihood of accidents due to impulsivity
  • Social difficulties: Challenges in maintaining relationships due to impulsive or inattentive behaviors
  • Substance misuse: Individuals with ADHD may be more prone to developing substance use disorders

• Tic disorders: Those with ADHD are more likely to be diagnosed with various types of tic disorder, including Tourette’s.

ADHD diagnosis

Diagnosing ADHD requires a comprehensive assessment, typically conducted by a healthcare professional specializing in mental health or developmental disorders. This process may involve:

• Clinical interviews: Gathering detailed history from the patient, family members, and teachers
• Behavioral rating scales: Using standardized tools to assess symptom frequency and severity
• Observational assessments: Evaluating behavior in multiple settings, such as home and school
• Ruling out other conditions: Ensuring symptoms are not due to other mental health issues, medical conditions, or environmental factors

ADHD prognosis

ADHD is a lifelong condition for many individuals, though symptom severity often diminishes with age. Early diagnosis and appropriate interventions significantly improve outcomes. Untreated ADHD may reduce life expectancy by up to 13 years.

Factors influencing prognosis include:

• Access to treatment: Effective management strategies, including medication and behavioral therapy, can reduce the impact of symptoms
• Support systems: Family, educational, and workplace accommodations play a crucial role in long-term success
• Comorbidity management: Addressing co-occurring conditions, such as anxiety or substance use disorders, is vital for holistic care

ADHD treatments

There are a number of drug and non-drug treatments for managing ADHD symptoms, including stimulant-based medications and various forms of therapy.

First-line treatments

• • Stimulant medications: Drugs like methylphenidate (Ritalin) and amphetamines (e.g. dextroamphetamine, aka Adderall) are widely prescribed to improve focus and impulse control by regulating dopamine activity in the brain
  • Non-stimulant medications: Options like atomoxetine (Strattera) or guanfacine (Tenex, Intuniv) may be used for individuals who do not respond to stimulants, have contraindications with other medications, or experience negative side effects with stimulants

• Anti-anxiety and antidepressant medications: Anxiolytics (anti-anxiety) drugs like buspirone, a serotonin agonist, may be prescribed. Various types of antidepressants may also be prescribed, e.g. monoamine oxidase inhibitors (MAOIs) like selegiline (Eldepryl, Zelapar). These can help regulate norepinephrine, serotonin, and dopamine signalling.

Other treatments

• Behavioral therapy: Techniques focusing on improving organizational skills, self-regulation, and adaptive behaviors
• Parent training: Equipping caregivers with strategies to support children with ADHD
• Educational support: Individualized education programs (IEPs) or 504 Plans can provide tailored accommodations

Adjunctive therapy & alternative treatments

• • Mindfulness and cognitive behavioral therapy (CBT): Both approaches can help with emotional regulation and stress management
  • Dietary modifications: Although evidence is mixed, some individuals report symptom improvements through balanced nutrition and avoiding food additives
  • Exercise: Regular physical activity has been shown to boost focus and reduce hyperactivity

• Herbal remedies: Herbal supplements like Ginkgo Biloba, ginseng, and herbal teas (e.g., chamomile) may be utilized to manage anxiety and insomnia in those with ADHD

Cannabis for ADHD

The use of medical cannabis as an adjunctive treatment for ADHD is a growing area of interest. Preliminary studies suggest that cannabis may:

• Help manage symptoms of hyperactivity and impulsivity
• Improve emotional regulation and reduce anxiety
• Enhance focus and task initiation in some individuals
• Provide alternatives to stimulant and anti-anxiety medications, which can cause side effects like insomnia, nausea, heart palpitations, and addiction

Cannabinoids and terpenes

• THC: May boost dopamine levels, improving focus and reducing hyperactivity
• CBD: Known for its anxiolytic and anti-inflammatory effects
• CBN: May have sedative properties to help with sleep disturbances
• Terpenes: Limonene, beta-caryophyllene, and pinene could reduce stimulant medication intake and aid in relaxation, helping manage anxiety and insomnia

Considerations

While cannabis shows promise, its effects can vary based on individual response, dosage, and age. Adolescents and younger individuals may be more sensitive to THC, with risks of anxiety or exacerbated ADHD symptoms if not used carefully. High-quality research is essential to determine long-term benefits and risks.

Additional information for patients

Patients with ADHD should work closely with healthcare providers to develop a personalized treatment plan. Key considerations include:

• Medication monitoring: Regular follow-ups are essential to assess effectiveness, and adjust dosages as needed
• Lifestyle adjustments: Maintaining a structured routine, prioritizing sleep, and incorporating stress-relief techniques can enhance overall well-being
• Educational resources: Joining support groups or accessing reputable ADHD-related materials can empower patients and families
• Open communication: Transparent discussions with educators, employers, and peers can foster understanding and create supportive environments

Special formulations and dosing

CBD- and CBN-rich products combined with beta-caryophyllene and limonene may offer particular therapeutic potential for ADHD. Common administration methods include tinctures, vaporizers, and edibles, tailored to individual needs.

Charities and organizations that serve those with ADHD include:

• ADHD Embrace
• Attention Deficit Disorder Association (ADDA)
• Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)

ADHD FAQs

What is the 30 rule for ADHD?

Some experts suggest that children with ADHD have an emotional and executive (ability to focus, organize, and manage) age 30% behind those of their peers.

What do people with ADHD struggle with?

Those with ADHD may experience the following symptoms:

• Anxiety
• Boredom
• Depression
• Impulsiveness
• Insomnia and sleep disorders
• Substance used disorder (SUD)
• Tics
• Trouble concentrating
• Trouble controlling anger

What is the 10-3 rule for those with ADHD?

The 10-3 rule refers to a system to improve executive function in those with ADHD, where 10 minutes of work is followed by 3 minutes of rest. This can help break tasks down, improve focus and concentration, and ensure task completion.

Resources

• Data and Statistics on ADHD: https://www.cdc.gov/adhd/data/index.html
• Attention Deficit Hyperactivity Disorder: https://www.ncbi.nlm.nih.gov/books/NBK441838/
• Attention-deficit/hyperactivity disorder: diagnostic criteria, epidemiology, risk factors and evaluation in youth: https://pmc.ncbi.nlm.nih.gov/articles/PMC7082246/
• Hyperactive Child Syndrome and Estimated Life Expectancy at Young Adult Follow-Up: The Role of ADHD Persistence and Other Potential Predictors: https://journals.sagepub.com/doi/10.1177/1087054718816164
• The efficacy of mindfulness-based interventions in attention-deficit/hyperactivity disorder beyond core symptoms: A systematic review, meta-analysis, and meta-regression: https://pubmed.ncbi.nlm.nih.gov/34146899/
• Non-Stimulant Treatment for Attention Deficit Hyperactivity Disorder: https://pmc.ncbi.nlm.nih.gov/articles/PMC3000197/
• Cannabis Use in Attention-Deficit/Hyperactivity Disorder (ADHD): A scoping review: https://pubmed.ncbi.nlm.nih.gov/36508935/ 
• Attention-Deficit Hyperactivity Disorder and Therapeutic Cannabis Use Motives: https://pmc.ncbi.nlm.nih.gov/articles/PMC11032069/
• Exploring the use of cannabis as a substitute for prescription drugs in a convenience sample: https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00520-5
• A Brain on Cannabinoids: The Role of Dopamine Release in Reward Seeking: https://pmc.ncbi.nlm.nih.gov/articles/PMC3405830/
• Use of Cannabidiol for the Treatment of Anxiety: A Short Synthesis of Pre-Clinical and Clinical Evidence: https://pmc.ncbi.nlm.nih.gov/articles/PMC7480724/
• A double-blind, randomized, placebo-controlled study of the safety and effects of CBN with and without CBD on sleep quality: https://pubmed.ncbi.nlm.nih.gov/37796540/
• Limonene Inhibits Methamphetamine-Induced Sensitizations via the Regulation of Dopamine Receptor Supersensitivity: https://pmc.ncbi.nlm.nih.gov/articles/PMC6609113/
• Are the Acute Effects of THC Different in Adults?: https://pmc.ncbi.nlm.nih.gov/articles/PMC8147270/

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