What is Attention Deficit Hyperactivity Disorder (ADHD)?
It is a pattern of behaviours which usually appear in childhood. Parents and teachers notice that a child is:
- unusually over-active.
- distracted, cannot stick to anything for any length of time.
- impulsive, does things on the spur of the moment or without thinking.
- unable to concentrate for any length of time.
Many of us might have one of these problems, but we do not have all of them. To have a diagnosis of ADHD1
, these problems must be bad enough to interfere with:
- How you get on with other people – or
- How you get on at work or school.
What happens as time goes on?
It tends to get better as you get older, but can continue into adult life2
. The over-activity usually gets less, but the impulsivity, poor concentration and risk-taking can get worse. These can make it hard to work, learn and get on with other people. It’s not surprising that adults with ADHD are more likely to experience depression, anxiety, feelings of low self-esteem and drug misuse and can feel overwhelmed and struggle in less structured environments.
How common is ADHD?
Around 3-6 in every 100 school-aged children have ADHD5
. For about 1 in 7 children with ADHD, their ADHD will continue into adulthood. About half will have some problems as adults, although not full ADHD6
. In children, boys are more commonly diagnosed than girls, where as in adults, there are more equal numbers of men and women seen in clinics7
How is ADHD/ADD diagnosed?
If you have these difficulties as a child or teenager, you would usually see either a Child and Adolescent Mental Health Service (CAMHS) or a Paediatric Service.
Specialist staff would see you for an assessment interview of 1-2 hours. They would need to talk to your family and teachers to understand your early childhood and any current problems.
If you have become aware of these problems as an adult, you would see a professional with expertise in ADHD from either a Community Mental Health team or a Neurodevelopmental Service. This is often a psychiatrist but may also be a specialist nurse or psychologist. The assessment will take 1-2 hours and will focus on the problems described above, and how troublesome they are.
The classification used in the UK is the ICD 10 system3. In the US, the DSM system4 allows for an “inattentive” type, without the over-activity. This is sometimes called Attention Deficit Disorder (ADD).
What can we done to help treat adults with ADHD/ADD?
Your psychiatrist or mental health professional can go over the advantages and disadvantages of medication and psychological interventions. They can be used on their own or together.
Cognitive Behavioural Therapy (CBT) and Mindfulness techniques and psychoeducational groups11,12,13
can help you to:
- Find ways to make sure that you do important tasks.
- Find ways to organise your life better.
- Get self-critical thoughts into perspective, and so feel better about yourself.
- Reduce unhelpful feelings of anxiety.
These are mostly ‘stimulant’ medications, related to amphetamines. They include methylphenidate (Ritalin, Concerta, Equasym), dexamphetamine (Dexadrine) and lisdexamfetamine (Elvanse). They work quickly, but the effect wears off during the night. It sounds strange that they should be useful in people with ADHD, but there is good evidence that they are. Slow-release preparations usually mean you can take tablets just once a day. These drugs can be misused so, in the UK, they are legally ‘controlled’ drugs. The dose will usually be more than that prescribed for children1,11,14. The side-effects include weight loss and occasionally, psychosis.
Atomoxetine (also known as Strattera) is a ‘non-stimulant’ medication. It can be useful in people who have side effects or where stimulant medication is less suitable. It takes several weeks to begin to have an effect. Side-effects can include stomach cramps and diarrhoea, and some people have reported ideas of self-harm.
How effective are these treatments?
Less research has been done into the medication treatments for adults with ADHD, than with children, so some medications are not yet licensed in adults, even though they are commonly used. Your psychiatrist can still prescribe them, but may need to make it clear that the prescription is ‘off license’.
Adjustments and support
You may cope better or be affected less by the symptoms of ADHD if your environment suits you. ADHD is considered a disability in the UK and therefore your school / college or place of work must make “reasonable adjustments” to support you.
Seeking help from others who understand the problems may be useful to both you and your partner or family. There are a number of self-help groups for adults with ADHD across the country and also some online forums.