What do we actually know about ADHD and what does it mean anyway?

Officially the title means attention deficit hyperactivity disorder. It is a disorder of brain processing. People who have this condition struggle to recognise, order, manage, and process, many forms of cognitive (brain) input. It is a complex condition that can be hard to recognise. However accurate recognition and correct treatment can make an enormous difference to the sufferer.
In years gone by it used to be called attention deficit disorder. However the change of name signalled the fact of greater understanding that the problem was not that people lacked willingness to pay attention, or that it only referred to attention, but there were other components in the disorder, including hyperactivity. However even the revised name is currently inadequate, since not all affected people show an obvious level of overactivity.
For example when I was a young graduate, we were taught that typical children with ADHD would be hyperactive. That is, they would be unable to sit still, they would find it very difficult to sit still in the classroom, and they would be constantly on the go, at home, even when playing sport, never sitting still for long, with a real difficulty focusing on tasks.

In actual fact that type of presentation is very straight forward in terms of making a diagnosis and providing treatment options to children. It is much trickier when the hyperactivity is not in the motor realm. That is to say, the person is not wandering around the room , but it may be in the intellectual sphere, which is to say, the young person or older adult may have a stream of thought is that is so rapid that they cannot process their thoughts and ideas. Coupled with this, they may have real difficultly settling down to any one subject matter to hand, and have real difficulty with attention and concentration.
Conversely, people with the condition can also sometimes have an ability to show intense “hyper focus”, such that they can show an intense concentration in a specific area for long periods of time, for example, with computer games, chess, tennis, fixing equipment or gadgets, dealing with computer problems, or intellectual ideas in a very focussed and particular area eg PhD students.

All of these things beg the question how one is to make the diagnosis if there are so many potential different features.

In addition these things are compounded by other aspects such as the personality of the young child or adult. If the person is temperamental, if they are very sensitive and finds their difficulties to be unsettling and distressing, the condition may manifest as the person being unhappy irritable unsettled and possibly quite troubled. It is very common for adolescents and teenagers who suffer from this condition to self medicate. This is often with recreational drugs and can be very problematic. If it is coupled with school failure, home life difficulties or alienation, the consequences can be disastrous.
It is well known that the prison population is over represented with ADHD sufferers, many of them never previously diagnosed.

Diagnosis

There are many tests available for ADHD. These mainly consist of validated questionnaires and assessments that can be administered by paediatricians, psychologists, psychiatrists and to a certain extent by us, your GPs.
It is important to establish that there is nothing else that is wrong at the same time, or another condition that is presenting as if the person has ADHD. This is the role of the GP.

Feedback from teachers in regard to academic performance and issues related to peer group, also is important.
There is some evidence that the use of electronic devices is making the condition more obvious and perhaps even having a role in triggering the condition in some people. It is certainly true that the proliferation of iPhones and social media means that young people are constantly able to be distracted by lots and lots of input, which they do not always have the ability to filter and manage. It can be overwhelming even for young people without brain processing difficulties.

On the other hand, being constantly bombarded with stimuli can suit some affected people very well, because for some sufferers of ADHD there is an intense craving for stimulation. For others, excess stimulation can be very unsettling. There is a school of thought that says hyper stimulation may unmask the condition. Clearly there are some aspects of social media and modern living that favours some people with ADHD, if they have a very short attention span and are able and comfortable to move rapidly from subject to subject.

Sometimes when we are seeing a young person they may have come due to concerns from parents or teachers or extended family. They may think that the person has ADHD , but the GP needs to look at the broader context. This is a condition that is inherited and it does tend to run in families. That being said it may not have been diagnosed in other siblings or previous generations.
For some of the reasons I have mentioned above, ADHD may present in an atypical fashion, or it may not have been experienced as being a problem. For example we can think of some sports people, whose rapid reflexes, quick reactions, intense speed and ability to move rapidly from point to point, favours their success. For example in tennis, AFL or other sporting areas, I regularly see people who are Stars, who I think have ADHD and who would not perform well in another arena, but in their chosen area, they are highly successful and very happy.

I have a friend who grew up in the country and he has been diagnosed as an adult with ADHD. However what he recalls from school days is running wild and playing a lot of sports and being very happy. He did not achieve his potential and was not able to pursue a University career. His diagnosis later in life has helped a lot but has also caused a lot of regret, in respect of chances that have been missed and opportunities that were not able to be taken up.
Therefore it is very important to diagnose it if it is causing a problem and if it is impeding the growth and development and fulfilment of potential of the person.
ADHD can occur at and manifest at any age. Children who are very intelligent and very relaxed may not present as having any problems. As stated previously the obviously much disrupted child is easy to diagnose and very straight forward to treat.

Who treats ADHD?

In general the formal diagnosis of ADHD must be made for a young person by a paediatrician and for those older than 16-18, by a psychiatrist. In either situation it is important that the person that you see is experienced with, and sympathetic to, the condition
This is because the medications that are used to treat it, while extremely useful for ADHD, can cause problems if used inapropriately and in the wider community. Therefore, the initiation of treatment is done by the specialist groups; however continuation of treatment or perhaps more importantly, exploring any suspicion you may have of diagnosis, can be started with your GP.

What you do if you think the child has ADHD?

Make an appointment and come in and discuss your child or adolescent. Make a longer appointment so there is time to talk through what is happening. It is not always appropriate for the young person to be present; sometimes it is more helpful for the parent/ caregiver to come in and speak to the doctor to outline history, past history, birth history, and attainment of milestones, academic performance, reports from teachers, friendship issues and things like this.

The cornerstone of diagnosis really is response to treatment. That is to say, if the person does not respond to appropriate medication, they are unlikely to have that particular diagnosis.
Treatment consists of replacing a neurotransmitter that is in relatively low supply in the brain. In other words, ADHD is essentially a brain condition. It is not that the child is lazy or destructive, deliberately being annoying, or that they are purposefully unhappy or high maintenance, defiant or difficult. The fact is, that they cannot see things through, follow complex instructions ,remember the sequence in which things are said, or pay attention long enough to understand what people are trying to communicate to them.

The other thing to say is that sufferers of this condition can have other conditions, co-existing. They may become quite anxious as a result of the continual apparent inability to meet the needs of others by failing to follow instructions. They may also be quite disheartened for the same reasons.
Adolescents may have substance abuse problems, where they have used recreational drugs such as cannabis to calm the mind and help them sleep. Sleep disturbance is a prominent feature of ADHD.

Summary

This is a long and complex subject, and the main point of this article is to say to you that if you think your child may be suffering from this condition, or indeed anyone in your family, or yourself could be suffering, make an appointment and come along. In our practice several of us particularly have a great interest in this condition and have successfully diagnosed this in a number of young people and adults.

Exploring and clarifying this question is very important and can make a world of difference to the person and the people around them. It is equally important to make sure if this is not what is wrong, to find out what really is wrong, and help the person with whatever difficulty it is that they are facing
If you have further questions or this is a subject that you want to know more about, make an appointment and we will it be pleased to explore it with you in more detail.

 

By Dr. Carmel O’Toole

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