Attention Deficit Hyperactive Disorder (ADHD) was something I knew little about growing up. I went to an all girls school so there weren’t that many hyperactive children (ADHD hyperactive subtype is more common in boys). At medical school, the psychiatric teaching was very limited and thus, my first real exposure to ADHD was, a personal experience, my darling husband.
My husband is extremely bright, gets easily distracted, thoughts bounce all over the place, you can be talking to him and he doesn’t even register, loses keys, wallet and sunglasses daily and is absolutely dreadful at admin! I thought this was just part of his charming character until I started specializing in Psychiatry and I learnt about ADHD and the concept that adults could also have ADHD. For several years I suggested he consider seeing a psychiatrist for a comprehensive assessment for ADHD and he fobbed me off as a ‘doctor wife over diagnosing her family’. I, eventually, discontinued the discussion.
In comes my gorgeous boy, Joseph. Joe is quirky, loves reading, absorbs interesting facts, has brilliant general knowledge but struggles to dress himself for school every day – if it’s not a priority for him it doesn’t happen. He is energetic, warm and compassionate, makes friends easily, loses everything, daydreams & fiddles in class, is super impulsive and he can battle with emotional regulation. He was missing more than half of what the teacher was saying.
Ultimately we took him for an educational psychological assessment and at the feedback session, my husband said ‘that sounds exactly like me’! The penny finally dropped! Greg wasn’t ‘lazy, unambitious, forgetful, distracted’. He had been trying so, so hard to fit into and operate in a ‘neurotypical’ world – an exhausting, highly stressful act that ultimately can have negative consequences. With this, my husband finally accepted his strengths and challenges.
ADHD is not a disease or a disorder, it’s just a different, genetically inherited, wiring of the brain. It affects in excess of 10% of school going children and the majority of symptoms persist into adulthood, with a variety of functional impairment. People who have ADHD have a reduced delivery of that delivers neurotransmitters (brain hormones) to the frontal lobe. The frontal lobe is one of the brain areas that developed evolutionary and is responsible for executive function. Executive function involves skills such as planning, organization, working memory, shifting flexibility, self-checking and ability to prioritize.
I tell my son that it’s actually a super-skill that you can ‘hyper-focus’ on things that you are interested in. It is however a battle to maintain focus on things that you consider mundane. I explain that school, and life in general, expects you to get through those boring tasks. Joseph has now embraced his ‘different brain’. In addition, one of his favorite characters in his favorite book has ADHD and he’s also a hero.
Like all ‘disorders’, there is a spectrum of severity. Treatment is multi-disciplinary and based on the individual’s functional impairments and any comorbidities.
First thing is to have a thorough assessment with a psychiatrist (child or adult) or paediatric neurologist– seeing a general practitioner (GP) is not appropriate. As mentioned above, ADHD is not well taught at medical school, other conditions need to be excluded and medication can be complex.
Educational assessments in children can be extremely sensitive in picking up specific signs and symptoms. Scales are useful – parents and teachers can do the SNAP questionnaire and adults can do a self-report questionnaire.
Executive functioning skills will always be more of a challenge for people with ADHD and thus structure and teaching organizational techniques to manage and remember things are vital. Fortunately technology is a big help (calendars, work flows, contact lists).
Other conditions that cause concentration issues such as learning disorders, intellectual disability, depression, anxiety, hearing & vision disorders and trauma must be excluded and managed.
If other conditions have been excluded and behavioural measures are not sufficient, medication may be considered.
There are two main categories of medication:
- Stimulants (work on dopamine)
- Non-stimulants (work on noradrenaline)
The choice of medication is complex and depends on:
- Main functional symptoms
- Demands of job/ school
Early identification and management of ADHD gives the best possible outcome! It promotes confidence, academic achievement and assists with challenging symptoms such as impulsivity and emotional dysregulation.
Failure to treat severe symptoms can lead to under-performance academically, anxiety, depression, acting out at school, social challenges and stimulant seeking behavior in teens.
- ADHD is real
- It’s not actually a disorder but a different wiring of the brain that leads to challenges with executive functioning
- >10% of population have brains wired this way
- You must be diagnosed & managed by a psychiatrist, not a GP
- Early diagnosis & intervention is key
- Treatment is complex but can be life-changing
See this amazing ADHD Success Story ‘Failing at Normal’