Written by Dr Jose Belda for Doctify
Attention Deficit Hyperactivity Disorder (ADHD) is a condition which we tend to associate with children. But what happens to these children when they grow up? Statistics reveal that 60% of children who have ADHD at the age of 13 carry the symptoms into adulthood. 50% of those adults will present with serious enough problems to warrant help from mental health services. Adult ADHD sufferers who are not diagnosed in childhood are likely to be misdiagnosed with various conditions before their ADHD is recognised and subsequently treated.
What symptoms does ADHD cause?
In essence, if you are impulsive, tend to be hyperactive or fidget, have difficulties organising or planning ahead and your attention span is short to the point that you struggle to finish a book or even a film, you might have ADHD. Those features do not start in adulthood though as in ADHD they are lifelong. They must also be pervasive to all situations. The parents of someone with ADHD often recall the difficulties their child had sleeping from a very early age or school reports of them being disruptive at school – sometimes to the point of being expelled from school. A common feature for people with ADHD who have not been diagnosed in childhood is that their full educational and hence professional potential has not been achieved. The impulsivity and sometimes irritability can interfere with relationships and make life difficult not just for the person with ADHD but also for the near and dear. Sleeping tends to be disturbed, with ADHD sufferers typically finding it takes a while to fall asleep because the brain keeps active and won’t “switch off”.
ADHD and drugs
ADHD is sometimes accompanied by problems with alcohol, cannabis and/or stimulants. People with ADHD cannot wait for a delayed gratification; they are more likely to develop addictions, including gambling addiction. But a common feature and something that helps the diagnosis of this condition is that the reaction to stimulants, like cocaine, ecstasy or speed is the opposite to the one experienced by people who do not have ADHD. Unless used in excessive amounts, these make people with ADHD feel that they can relax, focus and even sleep.
There is a scientific explanation for this. The brain of an ADHD sufferer functions in a different way. The part of the brain in charge of the executive function, the frontal lobe, has less of a natural substance called dopamine. Stimulant drugs increase the release of dopamine in the frontal lobe and hence in someone with ADHD will decrease impulsivity, decrease hyperactivity and help them to focus and relax.
This is the basis of the treatment of this condition. However, the illicit stimulants can be very addictive, and this is because they very rapidly activate a centre in the brain called the Nucleus Acumbens, which regulates pleasure. The quicker a substance acts upon this centre the more addictive the substance is. Whilst methylphenidate, the first line treatment for ADHD, is a stimulant, it is structured in a way that takes longer to activate the Nucleus Acumbens, so it decreases the risk of addiction. In fact, treating ADHD leads to a sixfold reduction in the risk of becoming addicted to substances.
How do psychiatrists help?
When it comes to making a diagnosis, the clinical presentation and the history are crucial. It is important to obtain detailed information about childhood and whenever possible from parents and, if available, from school reports. The paradoxical reaction to stimulant drugs (Ie relaxing on drugs like speed) is a very reliable test, but not everybody who suspects having ADHD has tried stimulants, and it cannot be recommended either.
Questionnaires like DIVA (from DIVA Foundation), Brown´s scale and Connor (for adults) are helpful tools to support the diagnosis, but they are based upon clinical experiences and the questionnaires in themselves are not diagnostic tools.
Methylphenidate, a stimulant medication, is the first line treatment for ADHD. When the response is suboptimal or the side effects are not well tolerated, there are other options which can be tried, like dexamphetamine or atomoxetine. However it is unusual that the condition will not respond to methylphenidate. If it is the case the diagnosis must be reviewed. There is strong evidence to treat this condition and, if it is severe enough, the benefits outweigh the potential side effects by far. The side effects of the methylphenidate tend to be short-lived, but poor appetite is the one that might stick around. I always advise to have a good breakfast before taking the morning medication. Appetite returns when the effect of medication ceases in the evening.
If I’m starting someone on medication I tend to prescribe immediate release Methylphenidate to be taken three times a day. When we’ve found the optimum dose I prescribe the equivalent dose of the slow release preparation, so it can be taken only once a day with the same effect. People find this option far more comfortable.
