Adult ADHD

In October 2011 the Royal College of Psychiatrists published a report titled ‘Attention Deficit Hyperactivity Disorder (ADHD) In Adults’.The leaflet itself is pioneering, in that it outlines the symptoms and treatment for the condition - often considered a child’s disorder - specifically for adults.

Key facts

Taken from the report:

• ADHD is a pattern of problems which starts in childhood, usually before the age of seven.
• Individuals with ADHD become distracted all the time, are impulsive, and have great difficulty concentrating.
• Around three to five in every 100 school-aged children have ADHD and more than two-thirds of those diagnosed with ADHD as children continue to have these problems as teenagers, with two-thirds of these having problems as adults.
• With age, the over-activity usually gets less. But impulsivity, poor concentration and risk-taking may become more of a problem. These will interfere with work, learning and relationships.
• In adults who have not been diagnosed in childhood, a specialist psychiatric assessment will be needed and patients will be asked to complete questionnaires on early childhood and current problems in order to be treated, usually with therapy and medication.

The stigma

The road to understanding more about ADHD has been a long one.

Today, people wrongly assume that the symptoms of ADHD always dissipate with age. Teachers and mental-health specialists alike have sometimes been found to be confused, ill-informed and misguided on how to detect, diagnose and treat ADHD effectively.

One infant-school teacher, who has worked with children with ADHD for over six years and who will remain anonymous, said that despite new research she remains “very doubtful about ADHD and diagnosis”.

“I think the behaviours associated [with ADHD] can be signs of other problems and there are real issues with masking things with drugs. I have seen several children diagnosed recently on the basis of one or two appointments and a tick-sheet from the school,” she said.

Where we are today

Although one of the most commonly studied and diagnosed psychiatric disorders in children – affecting around 8% globally – it is a disorder that can fall off the radar once a person reaches adulthood.

The condition affects every individual differently, which makes effective diagnoses difficult. Adolescents with ADHD (estimated at 4.7% of the overall American population) as they grow older, tend to develop coping mechanisms to compensate for their impairments. This can give the impression the disorder has been effectively dealt with.

Although this sounds like half the battle has been won, these self-made strategies can leave a person debilitated in their work and in their relationships

Breakthroughs

Research into ADHD has come a long way.

A recent edition of Progress in Neurology and Psychiatry included a report of a survey of psychiatric outpatient clinics, where one in five of adult referrals had diagnostic symptoms of ADHD.  The report concluded that the prevalence among the men and women attending the clinic studied was almost equal, with the most common diagnosis associated with ADHD being depression. But in the absence of clear diagnostic criteria for ADHD, such recognition is greatly dependent upon the clinician having suspicion of its presence and exploring the elements that might lead to its diagnosis.

What the experts are saying

According to one Harley Therapy doctor and psychiatrist, the UK is slowly catching up with the US in acknowledging that the illness does not go away with age and that ADHD brain changes do persist well into adulthood.

Doctor Steve Humphries, a general psychiatrist at Harley Therapy, who has witnessed the increase in adult ADHD sufferers seeking treatment, said: “I have only really approached [ADHD] in my practice during in the last few years. Prior to that, I was a little sceptical about the condition.

“[But] I started to see alot of people asking for treatment, particularly Americans who are more advanced in their awareness of the condition than we are in the UK currently [and] a recent audit shows that approximately 80% of adults with diagnostic symptoms of ADHD have a positive response or an extremely positive response to the current methods of treatment.

“People often learn how to manage their symptoms from childhood. But when they are stretched in higher education or highly skilled jobs, they find that their symptoms overwhelm them. It’s at this point that some people seek treatment for the first time, even though the condition may have been present since childhood.”

Humphries has worked with adult sufferers of ADHD for several years, and believes that today there is a “sizable case load” proving that the core symptoms can be significantly alleviated through a mixture of therapy and medication.

Diagnoses and treatment

To diagnose ADHD in adults most reputable doctors and psychiatrists will first use the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Criteria checklist, published by the American Psychiatric Association.

Humphries says: “I then use the Wender Utah Rating Scale (an aid to assess adults' retrospective account of the childhood occurrence of symptoms associated with ADHD) to identify childhood symptoms and further understand the condition in the adult.

“Once completed, I conduct a detailed psychiatric assessment face to face. A possible diagnosis is then followed by an offer of a month’s therapeutic trial of treatment.

“I principally treat people using medication, which aims to increase brain dopamine levels, which relieves the core symptoms. This treatment alone can be very effective but may also be backed up with Cognitive Behavioural Therapy and diet and exercise.”

Some people have described the changes they’ve seen in themselves as "miraculous" Humphries says. “They improve in their concentrational levels, their procrastination reduces and in some cases treatment has completely changed their lives.”

Another approach

Although modern research and case studies are proving that adults can be accurately diagnosed and treated like never seen before, it is not all down to the work done in the psychiatrist’s chair that makes the difference, according to Lorraine Barker – mother to 21-year-old ADHD sufferer, Alfie.

Mother-of-three Lorraine, a teaching assistant from Essex, said: “As soon as Alfie was born, we knew there was something different about him. But we loved him no differently. Acceptance is key and helps tremendously. There is no point in putting everything down to his ADHD or blaming the condition for everything that was wrong,” she said.

For Lorraine and Alfie, information about ADHD twenty years ago was not readily available on the Internet and doctors knew little about the condition in comparison to now.

Lorraine explained that growing up, Alfie struggled socially and disliked change. He was hyperactive and developed a terrible temper as he entered puberty, needing a lot of behavioural management both at school and at home. At age five, Alfie was prescribed Ritalin to manage his symptoms.

“For Alfie, it was awful,” she said. “It took away the Alfie we knew and loved and turned him into a walking zombie.”

“We read all the books and did all we could, but it’s all down to the individual at the end of the day. ADHD is a very personal condition and it’s personal for Alfie. Just like you and me have certain traits we can’t change, so does Alfie. And half the battle is accepting that this is the way he is.”

Through the modern research and technology, people in the UK are increasing their awareness of ADHD. People are successfully being diagnosed on the NHS across the country, but it may still take a time until every healthcare service can offer timely access to diagnosis and a treatment package for every child and adult.

You may like to read our blog by an adult sufferer of ADHD

See here for more information about the Royal College of Psychiatrists and Harley Therapy